动力髋螺钉、股骨近端防旋髓内钉及人工关节置换治疗老年股骨粗隆间骨折临床疗效比较

目的探讨动力髋螺钉(DHS)、股骨近端防旋髓内钉(PFNA)及人工关节置换不同植入物治疗老年人股骨粗隆间骨折的临床疗效。方法选取本院2010年12月至2012年4月收治的60例老年股骨粗隆间骨折患者随机分为三组:其中DHS组20例,PFNA组20例,人工关节置换术组20例,观察三组患者各组手术时间、术中平均出血量、围手术期并发症及Harris髋关节功能评分等指标。结果 60例患者随访12个月后,所有患者均获得骨性愈合。三组患者中,手术时间最短的是PFNA组,与其他两组比较,差异具有统计学意义(P<0.05)。此外,PFNA组患者术中出血量和围手术期并发症上较其他两组少,且在改良Harris髋关节评分功能上,PFNA组要优于其他两组,差异均具有统计学意义(P<0.05)。结论 DHS及PFNA固定与人工关节置换治疗老年股骨粗隆间骨折,均可获得满意的临床疗效。相对于DHS和人工关节置换,PFNA治疗股骨粗隆间骨折具有操作简单、出血少、手术时间短、固定可靠的优点,尤其适用于老年患者的股骨粗隆间骨折。

CHnical effect of DHS, PFNA and artificial joints replacement in the treatment of senile patients with intertrochanteric fractures.

Objective To study the curative effect of dynamic hip screw （DHS）, proximal femoral nail anti- rotation （PFNA）, and artificial joint replacement in the treatment of senile patients with inter trochanteric fractures. Methods Sixty senile patients of inter trochanteric fractures in our hospital from December 2010 to April 2012 were di- vided into three groups： DHS group （n=20, treated with DHS）, PFNA group （n=20, treated with PFNA）, and artificial joint replacement group （n=20, treated with artificial joint replacement）. The operation time, mean inlraoperative blood loss, postoperative complications, and the Harris hip function scores were observed. Results All patients were followed up for 12 months, which all obtained complete union. The operative time, blood loss, and perioperative complications of PFNA group were significantly less than those of the other two groups （P〈0.05）. The modified Harris hip score of PFNA group and artificial joint replacement group was superior to the DHS group （P〈0.05）. Conclusion The method of DHS, PFNA, and the artificial joint replacement all have good clinic curative effect in the treatment of inter trochanteric fractures. PF- NA is recommended to treat intertrochanteric fractures in senile patients for its advantages of simple operation, less bleeding, short operative time, and reliable fixation