两种不同内固定术治疗股骨转子间骨折的对比研究

目的:比较髋动力螺钉(DHS)和股骨近端髓内钉(PFN)两种内固定术式治疗股骨转子间骨折的疗效.方法:2006年8月～2011年4月,手术治疗股骨转子间骨折183例,其中稳定性骨折38例、不稳定性骨折145例;随机分为两组,PFN组90例用PFN内固定术治疗,DHS组93例用DHS内固定术治疗.比较两组患者的手术时间、术中出血量、下地行走时间、骨折愈合时间及髋关节功能评分等相关数据.结果:术后随访6～36个月,平均15.3个月.两组手术时间、术中出血量、下地行走时间比较,差异有统计学意义(P＜0.05),而骨折愈合时间比较差异无统计学意义(P＞0.05).对于稳定性股骨转子间骨折,两种术式疗效的优良率比较差异无统计学意义(P＞0.05);对于不稳定性股骨转子间骨折,PFN组疗效优于DHS组(P＜0.05).结论:DHST和PFN两种内固定术式分别有其各自的优点和适应证,都是治疗稳定性股骨转子间骨折的好方法,PFN对于不稳定性股骨转子间骨折的治疗更有优势.

A Comparative Study on Two Kinds of Internal Fixation for Femoral Intertrochanteric Fractures

Objective： To study two kinds of internal fixation of hip power screw （DHS） and proximal femoral nail （PFN） in the treatment of femoral intertrochanteric fractures. Methods： From August 2006 to April 2011, 183 cases of femoral intertrochanteric fractures （the stability of the fracture in 38 cases, 145 cases of fracture instability） were randomly divided into two groups： PFN group, 90 patients with PFN fixation treat- ment;DHS group, 93 patients with DHS fixation. Operative time, blood loss, walk time, fracture healing time and hip function score data in two groups were compared. Results：The patients were followed up for 6 to 36 months, with an average of 15.3 months. There were significant differences in operative time, blood loss, am- bulation time in the two groups ; there was no significant difference in fracture healing time. For unstable inter- trochanteric fracture, there was no significant difference. The excellent rate of PFN group was higher than that of the DHS group. Conclusions ： Both PFN and DHS have their respective advantages and indications ; they are good methods to treat unstable intertrochanteric fractures, the PFN treatment for unstable intertrochanteric frac- tures is better.