三种内固定治疗伴骨质疏松不稳定型股骨转子间骨折的比较研究

目的：比较动力髋螺钉（dynamic hip screw, DHS）、锁定加压钢板（locking compression plate, LCP）和股骨近端防旋转髓内钉（proximal femoral nail antirotation, PFNA）治疗老年人伴骨质疏松不稳定型股骨转子间骨折的治疗效果。方法对2010年10月至2014年8月我们治疗的103例股骨转子间骨折伴骨质疏松患者进行回顾性分析，按照Evans分型，Ⅲa型43例，Ⅲb型35例，Ⅳ型20例，R型5例。其中42例采用DHS治疗，30例采用LCP治疗，31例采用PFNA治疗。通过分析比较DHS、LCP和PFNA治疗骨质疏松性不稳定型股骨转子间骨折患者的手术时间、术中失血量、下地行走时间、骨折愈合时间、术后并发症及髋关节功能评分等方面的疗效。结果所有患者术后随访时间为6~30个月，平均为（14.5±3.2）个月。三组患者在手术时间、术中失血量、下地行走时间、骨折愈合时间比较，差异均有统计学意义（均P＜0.05）。PFNA组术后髋关节功能评分优于DHS组（P＜0.05）。三组患者在术后并发症比较，差异均无统计学意义（均P＞0.05）。结论 DHS、LCP、PFNA对于Ⅲa、Ⅲb、Ⅳ型骨质疏松性不稳定型股骨转子间骨折均为可行方法。因为PFNA手术时间、术中失血量、下地行走时间、骨折愈合时间和优良率等方面均优于LCP与DHS，对于R型骨质疏松性不稳定型股骨转子间骨折，应选用PFNA。

A comparative study of DHS, LCP and PFNA treating unstable intertrochanteric fractures in the osteoporotic elder patients

Objective To compare the therapeutic effect on unstable intertrochanteric fractures in the osteoporotic elder patients with dynamic hip screw (DHS), locking compression plate (LCP) and proximal femo?ral nail antirotation (PFNA). Methods A retrospective study was performed on 103 osteoporotic elder patients with unstable intertrochanteric fractures from October 2010 to August 2014. According to the type of Evans, there were 43 cases of theⅢa type, 35 cases of theⅢb type, 20 cases of theⅣtype and 5 cases of the R type. Totally 42 patients were treated with DHS, 30 patients with LCP, and 31 patients with PFNA, respectively. The data of operative time, blood loss, walking time, union time, hip function and postoperative complications were recorded. Results All patients were followed up for 6?30 months (14.5 ± 3.2 months on average). There were significant differences in operative time, blood loss, walking time, union time among three groups (P<0.05), and the PFNA group was superior to the DHS group on hip function (P<0.05). There was no significant dif?ference in postoperative complications among the three groups. Conclusion DHS, LCP and PFNA are effec?tive for the typeⅢa,Ⅲb andⅣof unstable intertrochanteric fractures in the osteoporotic elder patients, but PFNA is superior to than LCP and DHS in operative time, blood loss, walking time, union time, and the excel?lent rate. The PFNA is chosen in the fracture of the R type.