股骨近端锁定解剖钢板和PFNA治疗老年股骨粗隆间粉碎性骨折的疗效比较

目的探讨股骨近端解剖锁定钢板（LCP）和股骨近端髓内钉一抗螺旋刀片（PFNA）治疗老年粗隆间骨折的临床疗效。方法将2009年1月至2012年12月收治的60岁以上的股骨粗隆间粉碎性骨折（EvansⅢ、Ⅳ型）患者共63例，平均年龄（78．7±7．8）岁，按照随机分组原则分为两组，LCD组患者采用股骨近端锁定解剖钢板固定，PFNA组采用PFNA固定。比较两组患者的平均手术时间、术中出血量、术后下地负重活动时间以及髋关节功能恢复情况。结果PFNA组手术时间、术中出血量、术后下地负重活动时间明显低于LCP组，Harris评分术后3个月差异有统计学意义（P〈0．05），术后12个月差异无统计学意义（P〉0．05）。结论两种手术方法对于股骨粗隆间骨折均为有效的治疗措施，闭合复位PFNA内固定，手术简单，手术时间短，创伤小，骨折固定稳定，中远期疗效肯定，是较理想的治疗老年股骨粗隆间骨折的方法。

Comparison of proximal femoral locking plate and proximal femoral nail antirotation in treatment of senile intertrochanteric comminuted fracture

Objective To investigate the clinical curative effects of the anatomic proximal femoral locking plate （LCP） and the proximal femoral nail antirotation （PFNA） in the treatment of the senile femoral intertrochanterie fractures. Methods From January 2009 to December 2012, the patients over 60 year old with femoral intertroehanteric comminuted fracture （Evans Ⅲ, Ⅳ type ） were included in the study. There were 63 patients, with an average age of （78.7 ± 7.8 ） years. All the patients were randomized into two groups： the LCP group were treated with the proximal femoral locking plate, while the PFNA group were treated with proximal femoral nail antirotation. The two groups were compared in the mean operation time, the amount of intraoperative bleeding, the postoperative ambulating time with weight bearing, and hip function. Results The operation time, the amount of intraoperative bleeding and the postoperative ambulating time with weight bearing of the PFNA group was significantly lower than those of the LCP group. There was statistically significanct difference in Harris score of the two groups at the 3rd month （P 〈0. 05）, while at the 12th month there was no significant difference （P 〉0. 05）. Conclusion The two surgical methods arc both effective measures for the treatment of femoral intertrochanteric fracture. The closed reduction and internal fixation with PFNA is a simple operation, which has shorter operation time, smaller trauma and better stability. It is an ideal treatment for femoral trochanteric fracture of the senile.