动力髋部螺钉(DHS)和股骨近端髓内钉(PFN)治疗老年股骨转子间骨折的疗效分析

目的 探讨老年股骨转子间骨折两种内固定的手术适应证和手术方式选择。方法 随机选取64例高龄患者股骨转子间骨折，给予动力髋部螺钉(DHs)内固定术34例和股骨近端交锁髓内钉(PFN)内固定术30例，所有患者术前情况均采用100分制的量化评估标准进行手术适应性评估，记录两组术前、术中、术后的多项相关指标并予以统计学分析。结果 所有患者均随访12～28个月至骨折愈合，平均16个月，无死亡个案；PFN组与DHs组相比，手术时间、切口长度、术中失血量、总输血量、术后引流量和术后近期并发症均表现出明显的统计学差异。结论 高龄患者股骨转子间骨折需要术前给予100分制的量化标准进行评估，低于60分者应慎重手术；PFN内固定术具有适合高龄患者的骨质特点、固定牢靠、手术创伤小、并发症少的特性，较适用于老年人股骨转子间骨折。

Dynamic hip screws (DHS) and proximal femoral nails (PFN) in treatment of intertrochanteric fractures of femur in elderly patients

Objective To discuss the operative indications and choice of dynamic hip screws (DHS) and proximal femoral nails (PFN) in the treatment of intertrochanteric fractures of femur in elderly patients. Methods 64 elderly patients with intertrochanteric fracture of femur were randomized into 2 treatment groups: 34 cases were treated with DHS and 30 cases with PFN. The preoperative indications of all the cases were assessed quantitatively by the 100-mark system. All the preoperative, intraoperative and postoperative data of the 2 groups were observed and analyzed statistically. Results All the cases were followed up for 12 to 28 months. No one died, and all the fractures healed. The incision length, operation duration, intraoperative blood loss, total volume of blood transfusion, postoperative drainage and complications were statistically different between the 2 groups. Conclusions The indications of elderly patients with intertrochanteric fracture of femur should be quantitatively assessed with the 100-mark system. The operative treatment can be chosen only when absolutely necessary and should be done with great care for those whose marks are lower than 60. PFN internal fixation is more suitable for the elderly patients because it can result in more reliable fixation, less operative trauma and fewer postoperative complications.