两种内固定方法治疗高龄股骨转子间不稳定骨折的疗效分析

目的 比较股骨近端防旋髓内钉（PFNA）与股骨近端锁定钢板治疗高龄股骨转子间不稳定骨折的临床疗效.方法 回顾性分析我科2007年9月至2013年3月,102例股骨转子间骨折高龄患者（＞75岁）,排除Evans分型Ⅰ型、Ⅱ型骨折、合并两种及以上内科疾病、合并其他部位骨折、不能耐受麻醉及手术的患者.其中79例符合纳入标准.股骨转子间骨折按照Evans分型均为Ⅲ型～Ⅴ型骨折.本组研究病例从入院到手术时间为2～6 d,平均（3.5＆#177;1.0） d,随机采用PFNA或股骨近端锁定钢板,其中PFNA 43例,股骨近端锁定钢板36例.对照分析两组手术时间、术中出血量、骨折临床愈合时间、术后内固定并发症、髋关节功能.髋关节功能按末次随访Harris评分评价.结果 79例患者均得到较好随访,随访时间12.0～24.0个月,平均（14.0＆#177;2.8）个月.PFNA组Harris评分：优35例、良6例、可1例、差1例,优良率95.3%.股骨近端锁定钢板组：优19例、良8例、可4例、差5例,优良率75.0%.PFNA组较锁定钢板组临床愈合时间短（P＆lt;0.05）,内固定并发症较PFNA组高（P＆lt;0.05）,锁定钢板组发生4例内固定钢板断裂,PFNA组出现1例螺旋刀片切出头颈.手术时间、术中出血量两组差异无统计学意义（P＆gt;0.05）.两组患者均未出现切口感染,出现1例下肢深静脉血栓形成,3例术后肺部感染,均经治疗后治愈.结论 应用PFNA治疗高龄股骨转子间不稳定骨折手术创伤小、固定牢固、骨折愈合时间短、术后发生内固定并发症少,可早期下地负重,髋关节功能好,治疗效果满意.

Curative effectiveness of two internal fixation methods in the treatment of unstable intertrochanteric fractures in the elderly.

Objective To compare the clinical effects of proximal femoral nail antirotation （PFNA） vs. proximal femoral locking plate in the treatment of unstable femoral intertrochanteric fractures in elderly patients. Methods The clinical data of 101 elderly patients （more than 75 years old） with unstable intertrochanteric frac- tures treated in our hospital from September 2007 to March 2013 were analyzed retrospectively. After the exclu- sion of the patients with the Evans classification of fractures in type I or H , associated with two or more medical problems and the fractures at other positions, or un-tolerating anesthesia and surgery, 79 cases were enrolled in this study with age ranging from 75-87 years old. According to the Evans classification of fractures, all patients were fallen into type lIl to V. The patients were randomly divided into two groups, including PFNA group （n = 43）, and proximal femoral locking plate group （n = 36）. The operative time, perioperative blood loss, clinical fracture healing time, postoperative complications and hip function were compared and analyzed between two groups. Results For Harris score, the excellent and good rate in PFNA group was 95.3% （41/43）, and that in proximal femoral locking plate was 75 ~ （27/36）, respectively. The clinical healing time was shorter, and the in- cidence of complication was lower in PFNA group than in proximal femoral locking plate group （P〈0. 05 for all）. There was no statistically significant difference in the operative time and perioperative blood loss between the two groups （P〉0. 05）. Conclusion PFNA is effective for the elderly patients with unstable femoral intertrochanteric fractures.