老年股骨转子间骨折3种内固定治疗方法的比较

目的:比较动力髋钢板(DHS)、PFNA、InterTan治疗老年股骨转子间骨折的疗效。方法:回顾分析2007年2月至2012年5月收治并获得随访的136例老年股骨转子间骨折患者临床资料,男71例,女65例;年龄60～88岁,平均69岁。分别采用DHS(A组,80例)、PFNA(B组,36例)、InterTan(C组,20例)治疗,比较3组患者的手术时间、术中失血量、骨折愈合时间、髋内翻及股骨颈短缩畸形愈合、Harris髋关节功能评分。结果:所有患者术后获随访,时间2.5～14个月,平均4.1个月。B、C组与A组比较,手术时间、术中出血量、骨折愈合时间、髋内翻及股骨颈短缩畸形愈合发生、骨折固定失败例数、Harris总评分,差异均有统计学意义(P<0.05)。B、C两组的手术时间、术中出血量、骨折愈合时间、Harris髋关节功能评分比较,差异均无统计学意义(P>0.05)。C组与B组的髋内翻及骨折畸形愈合比较,差异有统计学意义(P<0.05)。结论:PFNA和InterTan治疗老年股骨转子间骨折的疗效均优于DHS,而InterTan在粉碎、复杂老年股骨转子间骨折疗效更优于PFNA。

Comparison of three fixations for treatment of intertrochanteric femoral fractures in the elderly

Objective: To compare the clinical effects of three internal fixations as follows:dynamic hip screw (DHS),proximal femoral nail-A (PFNA) and InterTAN,for intertrochanteric femoral fractures in elderly patients. Methods: From February 2007 to May 2012,136 elderly patients with intertrochanteric fractures (including 71 males and 65 females,ranging in age from 60 to 88 years old with an average of 69 years old) were treated with DHS (group A,80 cases),PFNA (group B,36 cases) and InterTAN (group C,20 cases). Statistical analysis were applied to compare the 3 groups in operative time,blood loss,fracture healing time,intrraoperative complications and functional outcome (Harris hip score). Results: The average follow-up was 4.1 months (from 2.5 to 14 months). Compared with group A,groups B and C showed significant advantages in operative time,blood loss,fracture healing time,and intrraoperative complications,functional outcome (Harris scores) (P<0.05). Compared with group B,group C had significant fewer intrraoperative complications (P<0.05). There were no significant differences in all the indexes except intrraoperative complications between groups B and C (P>0.05). Conclusion: The PFNA and InterTAN appear to be more reliable than DHS for the treatment of intertrochanteric femoral fractures in the elderly,but InterTAN appear to be more reliable in comminuted and complex intertrochanteric femoral fractures in the elderly than PFNA.