动力髋螺钉与股骨近端防旋髓内钉内固定术治疗高龄股骨转子间骨折患者的效果比较

Comparison of effects of dynamic hip screw and proximal femoral anti-rotation intramedullary nail internal fixation in treatment of elderly patients with femoral intertrochanteric fractures

目的:比较动力髋螺钉(DHS)与股骨近端防旋髓内钉(PFNA)内固定术治疗高龄股骨转子间骨折(IFF)患者的效果。方法:回顾性分析2021年1月至2023年12月陇西县中医医院骨科收治的82例高龄IFF骨折患者的临床资料,根据治疗方法不同将其分为对照组(n=40)和研究组(n=42)。对照组采用DHS内固定术治疗,研究组采用PFNA内固定术治疗,比较两组围术期指标水平,手术前后髋关节功能(Harris髋关节功能)评分、日常生活能力(PULSES功能评定量表)评分,以及术后6个月内并发症发生率。结果:研究组手术时间、住院时间、负重时间、骨折愈合时间均短于对照组,差异有统计学意义(P<0.05);术后,研究组畸形、活动度、疼痛、功能等Harris髋关节功能评分均高于对照组,差异有统计学意义(P<0.05);术后,研究组躯体状况、感觉功能、上肢功能、下肢功能、排泄功能、精神状况等PULSES评分均低于对照组,差异有统计学意义(P<0.05);研究组并发症发生率为2.38%(1/42),低于对照组的20.00%(8/40),差异有统计学意义(P<0.05)。结论:PFNA内固定术治疗高龄IFF骨折患者可提高髋关节功能评分,缩短围术期指标水平,降低PULSES评分和并发症发生率,效果优于DHS内固定术治疗。

Objective:To compare effects of dynamic hip screw(DHS)and proximal femoral nail anti-rotation(PFNA)internal fixation in treatment of elderly patients with femoral intertrochanteric fractures(IFF).Methods:The clinical data of 82 elderly patients with IFF fractures admitted to the department of orthopedics of Longxi County Hospital of Traditional Chinese Medicine from January 2021 to December 2023 were retrospectively analyzed.According to different treatment methods,they were divided into control group(n=40)and study group(n=42).The control group was treated with DHS internal fixation,while the study group was treated with PFNA internal fixation.The perioperative index levels,the hip joint function(Harris hip function)score and the daily living ability(PULSES function rating scale)score before and after the surgery,and the incidence of complications within 6 months after the surgery were compared between the two groups.Results:The operation time,the hospitalization time,the weight-bearing time and the fracture healing time of the study group were shorter than those of the control group,and the differences were statistically significant(P<0.05).After the surgery,the Harris hip function scores of deformity,activity,pain and function in the study group were higher than those in the control group,and the differences were statistically significant(P<0.05).After the surgery,the PULSES scores of physical status,sensory function,upper limb function,lower limb function,excretion function and mental status in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).Further,the incidence of complications in the study group was 2.38%(1/42),which was lower than 20.00%(8/40)in the control group,and the difference was statistically significant(P<0.05).Conclusions:PFNA internal fixation in the treatment of the elderly patients with IFF fracture can improve the hip function scores,shorten the perioperative index levels,and reduce the PULSES scores and the incidence of complications.Moreover,it is superior to DHS internal fixation.