DHS与PFNA治疗老年不稳定股骨转子间骨折的疗效比较

目的:探讨DHS和PFNA治疗老年不稳定股骨转子间骨折的临床疗效并进行对比分析。方法:2007年3月至2010年12月,作者通过手术治疗65岁以上的不稳定股骨转子间骨折42例,全部病例得到随访。对比分析手术时间、术中失血量、术后完全负重时间、骨折愈合时间、术后并发症及髋关节功能等。结果:本组随访12～37个月,平均25个月。DHS组与PFNA组在愈合时间上无统计学差异(P>0.05),但PFNA组手术时间、术中出血量、完全负重时间上明显少于DHS组,差异有统计学意义(P<0.05)。按Harris髋关节评分标准:DHS组优15例,良6例,可1例,差2例,优良率87.5%。PFNA组优15例,良2例,可1例,优良率94.4%。DHS组出现1例螺钉切出,1例出现颈干角丢失。结论:DHS和PFNA仍是目前最常用于治疗股骨转子间骨折的方法,PFNA与DHS相比操作简单,出血少,并发症少,是治疗不稳定股骨转子间骨折的理想方法,适用于各种类型的股骨转子间骨折。对于稳定性的转子间骨折选用DHS较合适,对不稳定性的骨折选用PFNA为首选,对于高龄老年患者,PFNA是最佳选择。

Analysis of DHS and PFNA for the treatment of unstable intertrochanteric fracture in elderly patients

Objective:To investigate the effect of DHS and PFNA for unstable intertrochanteric fractures in the elderly patients.Methods:Forty-two elderly patients(>65 years of age) with unstable intertrochanteric fractures were treated with DHS or PFNA.All patients were followed up 12 to 37 months(Mean 25months) after surgery.Operative time,intraoperative blood loss,complete weight bearing time,healing time,postoperative complications,and hip function of both groups were taken into comparison.Results:Twenty-four patients were treated with DHS and PFNA for the other 18 patients.There is no difference in healing time between patients who underwent DHS or PFNA(P>0.05),whereas those receiving PFNA had significantly less operative time,intraoperative blood loss,and complete weight bearing time(P<0.05).According to the Harris Hip score there were 15 excellent,six good,one fair,and two bad cases in DHS group.The excellent and good rates were 87.5%.In the PFNA group,there were 15 excellent,two good,and one fair cases.The excellent and good rates were 94.4%.However,there was one case with screw protrusion and one with neck-shaft angle loss,which occurred in the DHS group.Conclusion:PFNA is superior to DHS for the treatment of unstable intertrochanteric fractures;especially in the elderly patients.