股骨近端髓内钉与动力髋螺钉治疗老年股骨转子间骨折疗效比较

目的:探讨股骨近端髓内钉（PFN）与动力髋螺钉（DHS）治疗老年股骨转子间骨折的临床疗效。方法:选取158例老年股骨转子间骨折患者作为研究对象，其中行DHS治疗128例（DHS组），行PFN治疗30例（PFN组）。比较两种手术的治疗效果。结果:DHS组、PFN组A1、A2型骨折患者手术时间、术中出血量、术后引流量和愈合时间差异均无统计学意义（P>0.05）；DHS组A3型骨折患者手术时间、术中出血量、术后引流量及愈合时间均明显多于PFN组（P<0.01）；DHS组、PFN组A1、A2型骨折术后各时间点Harris评分差异均无统计学意义（P>0.05）；DHS组A3型骨折术后各时间点Harris评分均明显低于PFN组（P<0.01）；2组术后1、3、6个月疼痛VAS评分均明显低于术前（P<0.01），2组间VAS评分差异均无统计学意义（P>0.05）；PFN组A3型骨折患者的肺栓塞1例。结论:对于A1、A2型老年股骨转子间骨折PFN、DHS治疗均能取得满意疗效；对于A3型股骨转子间骨折，PFN具有更好的力学稳定性，效果优于DHS。

A comparative study of proximal femoral nail and dynamic hip screw treatment of femoral fractures in elderly

Objective:To investigate the clinical efficacy of proximal femoral nail(PFN) and dynamic hip screw(DHS) treatment of intertrochanteric fracture. Methods:One hundred and fifty-eight cases of intertrochanteric fractures in elderly patients were selected as research subjects, which 128 cases were treated with DHS, 30 cases were treated with PFN. Treatment effect of two surgery was compared. Results:There was no statistical difference about the operation time, blood loss, postoperative drainage, and healing time, between the group of DHS and PFN of A1, A2 patients with fractures ( P > 0. 05 );The Operative time, blood loss, amount of postoperative drainage and healing time in group of DHS patients with type A3 fracture were significantly more than in group of PFN( P<0. 01);postoperative Harris scores in type of A1 and A2 fractures at each time point had no statistical difference between group DHS and PFN(P>0. 05);The postoperative Harris scores of A3 fractures in group of DHS were significantly lower than that in group of PFN at each time point(P<0. 01);Pain VAS scores of each group 1 month,3 months,6 months postoperative were significantly lower than preoperative(P<0.01),There was no statistical difference between the VAS scores of all groups(P >0. 05);1 case of pulmonary embolism happened in group of PFN patients with A3 fracture. Conclusions:PFN,DHS has achieved satisfactory results for A1,A2 senile intertrochanteric fracture;Among A3 for intertrochanteric fracture,PFN has better mechanical stability,the effect is better than DHS.