股骨近端锁定钢板与PFNA治疗股骨近端骨折的对比研究

目的探讨股骨近端螺旋刀片抗旋髓内钉（PFNA）和股骨近端解剖型锁定接骨板治疗股骨近端骨折患者的临床疗效并进行对比分析。方法回顾性分析2009年6月~2011年6月采用PFNA和股骨近端解剖型锁定接骨板内固定治疗且随访时间超过12个月的股骨近端骨折46例的病例资料,采用PFNA内固定治疗者24例,采用股骨近端解剖型锁定接骨板内固定治疗者22例。对比分析2组患者术前美国麻醉学会（ASA）评分、手术时间和术中失血量、术后引流量、术后完全负重时间、骨折愈合时间、Parker-Palmer活动评分情况。结果所有患者获得3~12个月随访,平均7.2个月。两组术前ASA评分、手术时间、术中失血量、术后引流量和末次随访Parker-Palmer活动评分的差异均无统计学意义。股骨近端解剖型锁定接骨板组完全负重时间和骨折愈合时间较PFNA组延长。结论应用PFNA和股骨近端解剖型锁定钢板治疗股骨近端骨折手术创伤小,PFNA治疗者允许患者早期负重,骨折愈合加快。但对于骨质疏松严重,内固定切割风险高的患者,锁定钢板技术是现有内固定技术的有益补充。

A comparative study on clinical effects of proximal femoral nail antirotation blade and proximal femoral locking plate in the treatment of proximal femoral fractures

Objective To evaluate and compare the clinical effects of proximal femoral nail antirotation blade（PFNA） and proximal femoral locking plate（LCP） in the treatment of proximal femoral fractures.Methods A retrospective study was carried out in 46 patients with proximal femoral fractures who underwent PFNA or LCP between June 2009 and June 2011 and had a follow-up over 12 months,including 24 patients treated with PFNA and 22 with LCP.American Society of Anesthesiologists（ASA） score,operation duration,volume of blood loss,postoperative drainage volume,full weight bearing time,fracture healing time,Parker-Palmer mobility score were analyzed and compared between the two groups.Results The average follow-up period was 7.2 months（ranging from 3 to 12 months）.There were no statistically significant differences between the PFNA group and LCP group in terms of ASA score,operation time,volume of intraoperative blood loss,postoperative drainage volume and Parker-Palmer mobility score of the last follow-up.The full weight bearing time and fracture healing time were longer in the LCP group than in the PFNA group.Conclusion The application of PFNA and LCP in the treatment of proximal femoral fracture allows minimal wounds.Patients with PFNA treatment have earlier weight bearing and faster fracture healing.LCP is a useful supplement to the present internal fixation techniques for severe osteoporotic patients who take more risks if internal fixation incision is employed.