PFNA和DHS治疗老年股骨转子间骨折的疗效比较

[目的]比较防旋型股骨近端髓内钉(PFNA)和动力髋螺钉(DHS)与治疗老年股骨转子间骨折的疗效.[方法]回顾性分析2011年4月至2013年4月收治的132例65岁以上股骨转子间骨折患者的临床资料,根据内固定方式不同分为两组:DHS组70例,采用DHS内固定治疗;PFNA组62例,采用PFNA内固定治疗.比较两组患者的手术时间、手术切口长度、术中透视次数、术中出血量、骨折复位质量、住院时间、下地时间、骨折愈合时间、髋关节功能Harris评分及并发症发生率等.[结果]PFNA组患者的手术时间和切口长度较DHS组长,术中出血量较DHS组少,住院时间较DHS组短,下地时间较DHS组早,差异均有统计学意义(P<0.05).两组患者术中透视次数、骨折解剖复位或接近解剖复位率、围手术期并发症发生率比较差异均无统计学意义(P>0.05).DHS组54例患者获得随访,平均随访时间为(2.62±0.79)年;PFNA组47例患者获得随访,平均随访时间为(2.54±0.72)年.末次随访时DHS组患者髋关节功能Harris评分(81.29±9.38)分和优良率79.63%较PFNA组(94.68±4.90)分和95.74%低,差异有统计学意义(P<0.05),而两组患者的骨折愈合时间、术后并发症发生率比较差异均无统计学意义(P>0.05).[结论]对于老年股骨转子间骨折,与DHS相比,应用PFNA治疗具有稳定性好、手术时间短、术中出血量少及患髋关节功能恢复好的优势.

Comparison of the Curative Effects of PFNA and DHS Treatment Methods of Senile Femoral Inter-trochanteric Fracture

[Objective]To compare the curative effects of the Dynamic Hip Screw (DHS)and Proximal Femo-ral Nail Anti-rotation (PFNA)treatments of senile femoral intertrochanteric fracture.[Methods]Retrospective a-nalysis of the clinical data of 132 cases of senile patients with femoral intertrochanteric fracture from April of 2011 to April of 2013,and divided the 132 cases into two groups according to internal fixation methods.The DHS group had 70 cases,all using DHS internal fixation treatment.The PFNA group 62 cases,all using PFNA internal fixa-tion treatment.Afterwards,a comparison was made of the operation time,incision length,intraoperative fluoros-copy,intraoperative blood loss,quality of the reduction of fracture,down time,length of hospital stay,fracture healing time,hip function Harris score and the incidence of complications between the two groups of patients.[Re-sults]The operation time and incision length of the PFNA group were longer than the DHS group,however,the intraoperative blood loss was less than DHS group,hospitalization time shorter than the DHS group,and down time earlier than DHS group,the difference had statistical significance (P <0.05).The intraoperative fluoroscopy times,anatomical repositioning,anatomical reattachment rate,and complication incidence of preoperative of the two groups of patients had no statistical significance differences (P >0.05).54 patients of DHS group received follow-up,the average follow-up time being (2.62 ± 0.79)years;47 patients of PFNA group received follow-up, the average follow-up time being (2.54 ±0.72)years.The hip function Harris score (81.29±9.38)and good rate 79.63% of the DHS group of patients at the time of the last follow-up were lower than the PFNA group (94.68± 4.90)and 95.74%,the difference has statistically significant (P <0.05).The fracture healing time,postoperative complication rates of the two groups of patients had no statistical significance differences (P >0.05).[Conclu-sion]Compared with DHS,the biomechanical performance of PFNA was better,it causes small injuries,fewer postoperative complications,and applied more femoral intertrochanteric fracture type than DHS.