DHS、Gamma钉和PFN治疗老年股骨转子间骨折的临床研究

目的:比较采用动力髋螺钉(dynamic hip screw,DHS)、Gamma钉和股骨近端髓内钉(proximal femoral nail,PFN)治疗老年股骨转子间骨折的术中情况、术后并发症及疗效。方法:2001年2月-2005年5月,分别采用DHS(DHS组,56例)、Gamma钉(Gamma钉组,20例)和PFN(PFN组,51例)治疗并随访老年股骨转子间骨折患者127例。比较3组患者手术情况、术后并发症及功能恢复情况。结果:各组间手术时间两两比较均有显著差异(P<0．01),DHS组最长,PFN组最短。Gamma钉组和PFN组术中出血量少于DHS组(P<0．01)。DHS组发生术后髋内翻、肢体短缩及并发症总数多于Gamma钉组和PFN组(P<0．01)。DHS组、Gamma钉组和PFN组优良率分别为82．14％、85．00％和90．20％,组间疗效差异不显著(P>0．05)。结论:应用DHS、Gamma钉和PFN治疗老年股骨转子间骨折,在疗效方面无明显差异。Gamma钉和PFN可缩短手术时间、减少术中出血量及术后并发症。

The Clinical Study of the Treatment of Intertrochanteric Fractures in the Elderly with DHS, Gamma nail and PFN

Objective:To compare the operative procedures, complication incidence and postoperative functional restoration of the treatment to intertrochanteric fractures in elderly patients with dynamic hip screw (DHS) , Gamma nail and proximal femoral nail (PFN). Methods:From February, 2001 to May, 2005, One hundred and twenty-seven patients with intertrochanteric fractures were included in the study. Of all the patients, 56, 20 and 51 cases were treated by DHS, Gamma nail and PFN respectively. All the cases were followed up. The operative procedures, complication incidences and therapeutic effects of the three groups were compared. Results: There was significant difference in the mean operation time between each other among the three groups (P<0. 01). The mean intraoperative blood loss in DHS group was statistically more than those in the other two groups (P<0. 01). The number of patients with complications in DHS group was significantly higher than those in the other two groups (P<0. 01). The excellent rate of DHS group, Gamma nail group and PFN group was 82. 14%, 85. 00% and 90.20% respectively (P>0. 05). Conclusion:There was no significant difference among three operative methods as far as the therapeutic effect was concerned. Gamma nail and PFN may shorten the mean operation time, reduce the mean intraoperative blood loss and reduce the complication incidence.