可膨胀髓内钉与股骨近端髓内钉治疗老年股骨转子间骨折的比较

背景：股骨近端髓内钉具有较强的抗剪切力作用，可较好维持股骨近端旋转稳定性，手术操作简便，创伤较小，但存在应力过于集中于锁钉，置入固定螺钉前钻孔较大等缺点。 目的：比较可膨胀髓内钉与股骨近端髓内钉治疗老年股骨转子间骨折的临床疗效。 方法：将46例老年股骨转子间骨折患者随机分为两组，分别置入可膨胀髓内钉和股骨近端髓内钉内固定治疗。 结果与结论：置入可膨胀髓内钉组手术时间、术中出血量、切口长度及影像曝光时间均显著低于股骨近端髓内钉组(P < 0.01)，两组患者骨折愈合时间和平均住院时间、骨折愈合及髋关节功能优良率差异无显著性意义(P > 0.05)。表明与股骨近端髓内钉比较，可膨胀髓内钉具有手术时间短，出血量少，手术创伤小的优势。

Comparison of expandable intradullary nail and proximal femoral nail in the treatment of intertrochanteric fractures

BACKGROUND: Proximal femoral nail (PFN) is better to keep stability for the femur based on its strong anti-shearing force. It is easy to operate and causes fewer traumas. But it has defect of stress force concentration and larger aperture for locking pin, etc. OBJECTIVE: To compare the effects of expandable intramedullary nail system (Fixion PF) and PFN in the treatment of intertrochanteric fractures. METHODS: Forty-six patients with intertrochanteric fractures were randomly assigned into Fixion PF group and PFN group. The operation time, intraoperative blood loss, length of incision, X-ray exposure, duration of in-patient stay and time of bone union in both groups were recorded and compared. RESULTS AND CONCLUSION: The mean operation time, intraoperative blood loss, length of incisions and the X-ray exposure was significantly lower in the Fixion PF group than the PFN group (P < 0.01) There were no differences in mean time of bone union and in-patient stay in both group (P > 0.05). The excellent and good rate in Harris score was 91.6% in the Fixion PF group, greater than that in PFN group (90.9%), but there was no significant difference (P > 0.05). Compared with PFN protocol, introduction of Fixion PF displayed superiority in microinvasion at early clinical stage.