DHS和PFNA治疗老年股骨粗隆间骨折的效果比较分析

目的:探讨动力髋螺钉(DHS)和防旋股骨近端髓内钉(PFNA)治疗老年股骨粗隆间骨折的临床疗效。方法:回顾2008年1月-2010年1月98例老年股骨粗隆间骨折手术治疗患者,按内固定不同分为DHS组和PFNA组;按Evans-Jensen分型:DHS组56例中,I型12例,Ⅱ型18例,Ⅲ型15例,Ⅳ型11例。PFNA组42例中:I型10例,Ⅱ型13例,Ⅲ型11例,Ⅳ型7例,V型1例。分析2组患者的手术时间,术中出血情况,随访患者骨折愈合时间,观察有无股骨头切割、内固定松动等并发症,对比双侧颈干角,并采用Kuderna改良Merle DAubigne评分系统评估患髋功能。结果:术后随访时间12～24个月,平均12个月,DHS组:手术用时60～120min,平均90min;术中出血量300～600mL,平均400mL;骨折平均愈合时间10周;发生内固定松动或股骨头切割6例;发生髋内翻7例;PFNA组:手术用时45～100min,平均65min;术中出血量100～300mL,平均200mL;骨折平均愈合时间9周;发生内固定松动或股骨头切割0例;发生髋内翻2例;2组在手术时间、术中出血、内固定松动或股骨头切割及髋内翻等方面比较差异有统计学意义(P<0.05),在骨折平均愈合时间上比较差异无统计学意义(P>0.05)。Kuderna改良Merle D′Aubigne评分优良率:DHS组为85.7%,PFNA组为95.2%。均无感染,骨不连,股骨干骨折等并发症发生。结论:PFNA治疗老年粗隆间骨折疗效较DHS更为满意。

Comparative Analysis of the DHS and PFNA for Treating Intertrochanteric Femur Fracture of Elderly

Objective:To explore the clinical effect of dynamic hip screw(DSH) and proximal femoral nail anti-rotation(PFNA) for treating of intertrochanteric fractures.Methods:All 98 cases with intertrochanteric fractures were analyzed retrospectively from January 2008 to January 2010.And they were divided into DHS(56 cases) and PFNA groups(42 cases).According to Evans-Jensen type,there were 12 cases of type I,18 cases of type Ⅱ,15 cases of type Ⅲ,and 11 cases of type Ⅳ in the DHS group,and there were 10 cases of type I,13 cases of type Ⅱ,11 cases of type Ⅲ,7 cases of type Ⅳ,and 1 cases of type Ⅴ in the PFHA group.The operative time,intraoperative bleeding,fracture healing time,cut-out of femoral head,fixation loosening and other complications were compared and analysis between the two groups.And the Merle D′Aubigne scoring system which was modified by Kuderna was used to assess the hip function.Results:All patients were followed up for 12 months average(12~24months).The operating time was 60 to 120 minutes(90 minutes average),the intraoperative blood loss was 300 to 600 ml(400 ml average),and the average healing time of fracture was 10 weeks in the DHS group,and there was 6 cases with cut-out of femoral head or fixation loosened,and 7 cases with hip varus.While,the operating time was 45 to 100 minutes(65 minutes average),the intraoperative blood loss was 100 to 300 ml(200 ml average),and the average healing time of fracture was 9 weeks in the PFNA group,and there was no case with cut-out of femoral head or fixation loosened,and 2 cases with hip varus.The operating time,intraoperative blood loss,cut-out of femoral head or fixation loosened,and hip varus were significantly different between the two groups(P<0.05).But the bone healing time was not different between the two groups(P>0.05).The good rate was 85.7% in DHS group and 95.2% in PFNA group according to Kuderna modified Merle D′Aubigne scoring system.There was no complication such as infection,non-union,fracture of femoral shaft.Conclusion:PFNA is more satisfied than the DHS for treating intertrochanteric fractures in elderly.