PFLCP与PFNA治疗股骨粗隆间骨折的临床疗效比较

目的回顾总结应用股骨近端锁定加压接骨板(proximal femur locking compression plate,PFLCP)与股骨近端螺旋刀片抗旋髓内钉(proximal femoral nail antirotation blade,PFNA)两种手术内固定治疗股骨粗隆间骨折的临床疗效并进行对比分析。方法从2008年7月至2011年10月,收治股骨粗隆间骨折56例,随机分为两组,一组采用PFLCP内固定,另一组采用PFNA内固定。术后分析手术时间、伤口大小、失血量、完全负重时间、骨折愈合时间及内固定位置情况,并通过Harris功能评分评价下肢功能。结果两组顺利完成手术,术后均定期完成随访,平均随访12个月(8～18个月)。PFNA组在切口长度、术后负重时间均优于PFLCP组(P<0.05),两组在手术时间、术中失血量、骨折愈合时间方面比较差异无统计学意义(P>0.05)。PFLCP组出现2例髋内翻、螺钉松动退出、股骨大粗隆滑囊炎,PFNA组2例分别出现颈干角丢失、螺钉切出股骨头和下肢轻度短缩、螺钉稍退出。结论 PFNA和PFLCP两种内固定在股骨粗隆间骨折治疗中均具有较好疗效,PFNA固定允许患者早期负重,两种内固定均具有自己的优势。

Comparison of the Clinical Effect of PFLCP and PFNA for the Treatment of Intertrochanteric Fractures

Objective Review and compare the clinical efficacy of the proximal femur locking compression plate(PFLCP) and femur proximal spiral blade intramedullary nail anti-rotation(PFNA) internal fixation for intertrochanteric fractures.Methods From July 2008 to October 2011,56 cases of femoral intertrochanteric fracture were treated.Patients were randomly divided into two groups,one group was treated with proximal femoral locking plate LCP internal fixation,another group with proximal femur spiral blade anti-rotary intramedullary nail fixation.Postoperative analysis includes the operative time,wound size,blood loss,full weight bearing time,fracture healing time and the efficacy of the fixation.The Harris scores was used to evaluate lower limb function.Results All of the surgeries were successful.Patients are regularly followed-up for an average of 12 months(8 months to 18 months).The PFNA groups had shorter incision length,earlier postoperative weight-bearing than PFLCP group(P<0.05).The difference of operative time,intraoperative blood loss,fracture healing time of the two groups was not statistically significant(P>0.05).Two cases of PFLCP group had hip varus,screws loose,and greater trochanter bursitis.Two cases of PFNA group lost the neck shaft angle,screws cutting out of the femoral head and mild lower extremity shortening,screw exit.Conclusion PFNA and PFLCP internal fixation were both effective in intertrochanteric fractures.The PFNA fixation allow patients with early weight-bearing.