PFNA与DHS治疗高龄不稳定股骨转子间骨折的疗效比较

目的:比较股骨近端防旋髓内钉(proximal femoral nail anti rotation,PFNA)与动力髋螺钉(dynamic hip screw,DHS)治疗高龄不稳定股骨转子间骨折的临床疗效。方法:2012年1月至2015年12月收治的83例高龄不稳定股骨转子间骨折患者分为采取PFNA治疗的45例与采取DHS治疗的38例。PFNA组中男24例,女21例;年龄82~94(88.35±6.12)岁;病程1.5~10(4.33±1.07) h;交通事故33例,高空坠落10例,跌倒伤2例;Evans-Jensen分型:ⅢA型21例,ⅢB型18例,Ⅳ型6例。DHS组中男20例,女18例;年龄83~95(88.77±5.52)岁;病程1~10(4.37±1.05) h;交通事故27例,高空坠落10例,跌倒伤1例;Evans-Jensen分型:ⅢA型18例,ⅢB型15例,Ⅳ型5例。观察比较两组手术时间、术中出血量、出院时并发症。利用健康调查简表(the Mos 36-item Short Form Health Survey,SF-36)测定术前及术后12个月生活质量。采用Harris评分评价术后12个月髋关节功能。结果:PFNA组手术时间、术中出血量、并发症发生率均明显低于DHS组(P<0.05);两组患者均获得12个月随访,期间无脱落,两组术后12个月Harris评分、SF-36评分均高于术前(P<0.05),PFNA组均明显高于DHS组(P<0.05);PFNA组优良率高于DHS组(P<0.05)。结论:与DHS相比,PFNA治疗高龄不稳定股骨转子间骨折操作更为简便、创伤更小、并发症更少、短期优良率与患者生活质量更高,可作为治疗高龄不稳定股骨转子间骨折的优选治疗方法。

Comparison of PFNA and DHS for the treatment of elderly unstable intertrochanteric fractures of femur

Objective:To compare the clinical efficacy of proximal femoral nail anti-rotation(PFNA) and dynamic hip screw(DHS) for the treatment of unstable intertrochanteric fractures in the elderly. Methods:From January 2012 to December 2015,83 elderly patients with unstable intertrochanteric fracture of femur were divided into 45 cases treated with PFNA and 38 cases treated with DHS. In the PFNA group,there were 24 males and 21 females,aged 82 to 94(88.35±6.12) years old,duration was 1.5 to 10 (4.33±1.07) h,causes of injury involved 33 traffic accidents,10 falls at high altitude,2 falls;Evans-Jensen classification involved 21 cases of ⅢA,18 cases of ⅢB and 6 cases of Ⅳ. In DHS group,there were 20 males and 18 females,aged 83 to 95 (88.77±5.52) years old,duration was 1 to 10 (4.37±1.05) h,27 traffic accidents,10 high-altitude falls and 1 fall injury,and Evans-Jensen classification involved 18 cases of ⅢA,15 cases of ⅢB and 5 cases of Ⅳ. The operation time,intraoperative bleeding volume and discharged complications were observed and compared between the two groups. The Mos 36-item Short Form Health Survey (SF-36) was used to measure the quality of life before and 12 months after operation. Harris score was used to evaluate hip function 12 months after operation. Results:The operation time,intraoperative bleeding volume and complication rate in PFNA group were significantly lower than those in DHS group(P<0.05);both groups were followed up for 12 months without falling off. The Harris score and SF-36 score at 12 months after operation in both groups were higher than those before operation(P<0.05),and the excellent and good rate in PFNA group was significantly higher than that in DHS group(P<0.05). Conclusion:Compared with DHS,PFNA is more simple,less traumatic,less complications,better short-term survival rate and better quality of life for elderly patients with unstable intertrochanteric fracture of femur. PFNA can be used as an optimal treatment for elderly patients with unstable intertrochanteric fracture of femur.