PFNA与PFN内固定治疗老年股骨粗隆间骨折的临床疗效评价

Comparison of the clinical efficacy in treating the elder femoral intertrochanteric fracture with PFNA and PFN

目的探讨PFNA(股骨近端抗旋髓内钉)与PFN(股骨近端重建钉)内固定治疗老年股骨粗隆间骨折的治疗效果。方法 2010年5月~2012年12月采用C臂透视下闭合复位PFNA内固定治疗老年股骨粗隆间骨折108例为PFNA组,随机选取同时期病例采用PFN内固定治疗老年股骨粗隆间骨折102例为PFN组,记录手术时间、术中出血量、手术前后血红蛋白值、术后完全负重时间、术后并发症及末次随访时患髋Harris评分,对二者的疗效进行回顾性分析比较。结果两组术后均随访8~24个月,PFNA组1例发生下肢深静脉血栓。全部病例未发生螺旋刀片骨内切割、松动移位,骨折全部愈合。PFN组6例发生髋部加压螺钉松动,其中骨折畸形愈合2例,2例行PFNA翻修治疗,2例行人工关节置换补救手术治疗。两组手术时间、术中出血量、术后血红蛋白值、术后完全负重时间、术后并发症比较差异有统计学意义(<0.05)。术前血红蛋白值、末次随访髋关节Harris评分无统计学意义(>0.05)。结论采用PFNA微创内固定治疗老年股骨粗隆间骨折可以减少医源性血运破坏、骨质丢失,操作简单、缩短手术时间、减少术中出血量,可有效固定骨折,减少并发症,有利于骨折愈合,临床疗效满意,是老年股骨粗隆间骨折理想的治疗方法。

Objective To evaluate the clinical outcome in treating the elder femoral intertrochanteric fracture with PFNA and PFN. Methods 210 elderly patients with femoral intertrochanteric fracture were enrolled in this study from March2010 to December 2012, who were all treated by the closed reduction and internal fixation technique through C-arm Xray machine. Of them, 108 patients(PFNA Group) were treated with PFNA, 102 patients(PFN Group) with PFN.The datas such as:the operative time, intraoperative blood-losing, pre- and post-operative hemoglobin values,postoperative full weight-bearing time, complications and, Harris scores at the final follow-up were all recorded and analyzed. Results All 210 patients were followed up 8 to 24 months. All patients in the PFNA Group got satisfactory fracture healing, no the helical blade bone cutting or displacement, but 1 patient occurred the DVT. The hip compression screw loosened in6 patients of the PFN Group, including 2 cases fracture malunion, PFNA overhaul treatment in 2 cases, and the artificial total hip joint replacement operation in 2 cases. Significant differences(P<0.05) were observed in the the operative time,intraoperative blood-losing, postoperative hemoglobin values, postoperative full weight-bearing time and complications.No significant difference(P >0.05) was found between PFNA Group and PFN Group in preoperative hemoglobin values and Harris scores at the final follow-up. Conclusion The minimally invasive internal fixation technique with PFNA is an ideal treatment for the elder femoral intertrochanteric fracture, which can reduce iatrogenic blood supply damage and bone loss, shorten the operation time, decrease the intraoperative blood-losing, reduce the postoperative complications, fix the fracture effectively, and therefore can obtain better fracture healing, more satisfactory clinical efficacy comparing to the PFN Group.