动力髋螺钉与股骨近端防旋髓内钉治疗老年股骨粗隆间不稳定骨折的病例对照研究

目的：回顾对比应用动力髋螺钉（dynamic hip screw，DHS）和股骨近端防旋髓内钉（proximal femoral nail anti-rotation，PFNA）内固定治疗老年股骨粗隆间不稳定骨折疗效优劣。方法：2004年8月至2012年8月，采用DHS和PFNA内固定治疗股骨粗隆间不稳定骨折92例，其中DHS组50例，男27例，女23例，平均年龄（72．5±5．3）岁；PFNA组42例，男22例，女20例，平均年龄（72．8±5．8）岁。对两组手术时间、失血量（包括隐性失血和显性失血）、卧床时间、下地负重时间、术后并发症及髋关节评分等进行比较。结果：术后随访10～18个月，平均13．5个月。PFNA组较DHS组手术时间和显性失血少，隐性失血多。PFNA组并发症发生率低于DHS组，疗效优于DHS组。髋关节Harris评分PFNA组高于DHS组。结论：治疗高龄股骨粗隆间不稳定骨折，在髋关节功能恢复和减少并发症方面，PFNA效果更好；对于Ⅱa、IIb、Ⅲ型骨折采用DHS可获取良好疗效，在减少围手术期失血方面具有优势。

Case-control study on dynamic hip screw and proximal femoral nail anti-rotation for the treatment of unstable intertrochanteric fractures in elderly patients

Objective：To retrospectivly compare the clinical efficacy of dynamic hip screw （DHS） with proximal femoral nail anti-rotation （PFNA） for the treatment of unstable intertrochanteric fractures in the elderly. Methods ：Totally 92 elderly patients with unstable intertrochanteric fractures were treated with DHS including 27 males and 23 females with a mean age of （72.5＋5.3） years old ] and PFNA including 22 males and 20 females with a mean age of （72.8＋5.8） years old] from August 2008 to August 2012. The data of operation time,blood loss （obvious and hidden blood loss） ,bedridden time, down load time, postoperative complications and Harris hip function score were recorded and compared. Results： Both of two groups were fol- lowed-up for 10 to 18 months with an average of 13.5 months. PFNA was implanted with a significantly smaller incision and shorter clinical healing time, less blood loss, while hidden blood loss were more. Postoperative complications, therapeutic ef- fects and Harris score in PFNA group were better than that of DHS group. Conclusion： For treatment of senile patients with un- stable intertrochanteric fractures, PFNA was superior to DHS in reducing complication rates,recovering hip joint,while DHS could reduce perioperative blood loss in treating type II a, IIb and m fracture.