动力髋螺钉与股骨近端防旋髓内钉治疗老年外侧壁危险型股骨转子间骨折的临床研究

Clinical Efficacy of Two Surgical Treatments for Risky Lateral Femoral Intertrochanteric Fracture of Elderly

目的 比较动力髋螺钉(DHS)与股骨近端防旋髓内钉(PFNA)治疗老年外侧壁危险型股骨转子间骨折的临床疗效。方法回顾性分析2012年1月至2018年1年于我院行手术治疗并进行随访的109例老年外侧壁危险型股骨转子间骨折患者临床资料,其中PFNA组58例,DHS组51例,比较两组患者的手术时间、术中失血量、切口长度、住院时间、术后骨折愈合时间、并发症发生率、完全负重时间、术后1年髋关节功能优良率、术中和术后继发性外侧壁骨折发生率。结果 PFNA组手术切口长度、术中出血量、手术用时、住院时间、骨折愈合时间、完全负重时间、术后1年髋关节功能优良率、继发性外侧壁骨折发生率均优于对照组,差异均有统计学意义(P<0.05)。结论 PFNA与DHS可有效治疗老年外侧壁危险型股骨转子间骨折,PFNA具有手术创伤小、恢复快、髋关节功能恢复佳等优点,DHS有出现外侧壁破裂风险。对于老年外侧壁危险型股骨转子间骨折,推荐使用PFNA治疗。

Objective To compare clinical outcomes of DHS and PFNA in treatment of risky lateral femoral intertrochanteric fracture of elderly patients. Methods One hundred and nine elderly patients with risky lateral femoral intertrochanteric fracture treated in Yeda Hospital of Yantai from January 2012 to January 2018 were retrospectively compared. Fifty-eight patients were treated with PFNA(group PFNA), 51 patients were treated with DHS(group DHS). Follow-up assessment included the operation time, amount of bleeding, surgical incision,hospitalization time, fracture healing time,full weight-bearing time after operation,incidence of lateral wall fracture, postoperative complication rate and Harris score at 1 year after operation. Results There were statistical differences between PFNA and DHS treated groups in operation time, amount of bleeding, surgical incision, hospitalization time, fracture healing time, full weight-bearing time after operation, incidence of lateral wall fracture and Harris score at 1 year after operation(all P<0.05). Conclusion The treatment of elderily pertrochanteric fractures with lateral wall risky in PFNA can reduce the incision length, operation time, intraoperative bleeding and hospitalization time, and have fewer surgical complications, early postoperative load,quick recovery of fracture, and good recovery of hip function. The group of DHS had the high risk of lateral wall fracture, and the PFNA is worth clinical promotion.