股骨近端防旋髓内钉与动力髋螺钉修复老年股骨转子间骨折的比较

背景：对于年轻患者股骨转子间骨折，大部分内固定方法均能提供有效而坚固的固定；而对于老年性骨质疏松性转子间骨折类型，何种内固定的疗效最佳尚在争论。目的：比较股骨近端防旋髓内钉与动力髋螺钉置入内固定修复股骨转子间骨折的临床疗效。方法：选取2010年1月至2013年1月苏州市相城人民医院收治，采用股骨近端防旋髓内钉或动力髋螺钉治疗股骨转子间骨折患者的临床资料。根据纳入标准，最终140例146髋纳入研究，其中股骨近端防旋髓内钉组70例（74髋），动力髋螺钉组70例（72髋），两组患者术前一般资料比较差异无显著性意义（P〉0.05），具有可比性。比较两组患者手术时间、失血量、平均住院时间、术后下地时间、围手术期血红蛋白丢失量、术后并发症、骨折愈合时间及髋关节Harris评分等指标以评估疗效。结果与结论：140例患者均获随访，随访时间8-16个月，所有患者切口均Ⅰ期愈合。相比动力髋螺钉组，股骨近端防旋髓内钉组在手术时间、术中失血量、术后下地行走时间、平均住院天数方面均更具优势，差异有显著性意义（P〈0.05），但两组在围手术期血红蛋白丢失、骨折愈合时间、术后Harris评分等方面差异无显著性意义（P〉0.05）。提示股骨近端防旋髓内钉与动力髋螺钉置入内固定修复股骨转子间骨折均能获得较满意的临床疗效，但股骨近端防旋髓内钉具有手术时间短、失血量少、平均住院时间短、术后下地时间早及术后并发症少等优点。

Proximal femoral nail anti-rotation versus dynamic hip screw in the repair of intertrochanteric fracture in the elderly

BACKGROUND：For younger patients with intertrochanteric fractures, many fixation methods can provide an effective and robust fixation, but for elderly patients with osteoporosis intertrochanteric fracture, there remains debate for which fixation method is optimum. OBJECTIVE：To compare the clinical outcomes of proximal femoral nail anti-rotation and dynamic hip screw in the repair of intertrochanteric fracture. METHODS：Clinical data of patients with intertrochanteric fracture treated by proximal femoral nail anti-rotation or dynamic hip screw at the Suzhou Xiangcheng People’s Hospital from January 2010 to January 2013 were selected. In accordance with the inclusion criteria, 140 patients （146 hips） were included, containing 70 patients in the proximal femoral nail anti-rotation group （74 hips） and 70 patients in the dynamic hip screw group （72 hips）. No significant difference in preoperative general data was detected in patients of both groups （P〉0.05）, showing a comparability. Operative time, intra-operative blood loss, the average length of hospital stay, postoperative ambulation time, perioperative hemoglobin loss amount, postoperative complications, healing time, and Harris score were compared and evaluated in both groups. RESULTS AND CONCLUSION：140 patients were fol owed up for 8-16 months. The incision was stage I healing. Compared with dynamic hip screw group, operative time, intra-operative blood loss, the average length of hospital stay, and postoperative ambulation time were better in the proximal femoral nail anti-rotation group （P〈0.05）. However, no significant differences in perioperative hemoglobin loss amount, healing time, and postoperative Harris score were visible in the both groups （P〉0.05）. These findings suggested that proximal femoral nail anti-rotation and dynamic hip screw in the repair of intertrochanteric fracture could obtain satisfactory clinical outcomes, but proximal femoral nail anti-rotation has some advantages such as short operative time, l