螺旋刀片抗旋髓内钉与动力髋螺钉治疗老年股骨粗隆间骨折患者的疗效比较

目的：比较股骨近端螺旋刀片抗旋髓内钉（ PFNA）与动力髋螺钉（ DHS）在老年股骨粗隆间骨折患者治疗中的应用效果。方法92例老年股骨粗隆间骨折患者按数字表法随机分为PFNA组46例、DHS46例，分别给予PFNA与DHS内固定治疗，比较两组临床效果。结果 PFNA组手术时间、术后下地活动时间、总住院时间、术中出血量及术后切口引流量分别为（58．3±19．7） min、（7．4±4．1） d、（16．1±6．2） d、（97．6±34．7）mL、（64．7±12．4） mL，均优于DHS组的（81．3±20．4） min、（11．4±3．8） d、（19．7±5．8） d、（206．3±35．4）mL、（75．2±12．8）mL（t＝5．500、4．853、2．875、14．872、3．996，均P＜0．01）；术后1年PFNA组患者髋关节Harris评分为（88．5±6．2）分，高于DHS组的（84．3±5．8）分（t＝3．355，P＜0．01），髋关节功能良好率为93．5％，显著高于DHS组的73．9％（χ^2＝6．451，P＜0．05）；两组术后并发症发生率差异无统计学意义（χ^2＝1．011，P＞0．05）。结论 PFNA用于老年股骨粗隆间骨折可在不增加术后并发症基础上以较小的创伤、较短的时间完成手术，患者术后下地活动时间早，髋关节功能恢复好，值得推广。

Comparison of the effect of PFNA and DHS in the treatment of elderly patients with intertrochanteric femur fracture

Objective To compare the effects of proximal femoral nail antirotation （ PFNA） and dynamic hip screw （ DHS） in the treatment of elderly patients with intertrochanteric femur fracture .Methods According to the digital table ,92 elderly patients with intertrochanteric femur fracture were randomly divided into the PFNA group （ n=46） and the DHS group（n=46）.The PFNA group was treated with PFNA and the DHS group was treated with DHS . The clinical effect was compared between the two groups .Results The operation time ,postoperative ambulation time , hospitalization time,blood loss and postoperative wound drainage of PFNA group were （58.3 ±19.7） min,（7.4 ± 4.1）d,（16.1 ±6.2）d,（97.6 ±34.7）mL,（64.7 ±12.4）mL,respectively,which were better than those of DHS group（81.3 ±20.4）min,（11.4 ±3.8）d,（19.7 ±5.8）d,（206.3 ±35.4）mL,（75.2 ±12.8）mL]（t=5.500, 4.853,2.875,14.872,3.996,all P〈0.01）.1 year after operation,the Harris score of hip joint of PFNA group was （88.5 ±6.2）points,which was higher than that of DHS group （84.3 ±5.8）points]（t=3.355,P〈0.01）.The rate of good hip function was 93.5%,which was significantly higher than that of DHS group （73.9%）（χ^2 =6.451,P〈0.05）.The incidence rate of postoperative complications between the two groups had no statistically significant differ -ence（χ^2 =1.011,P〉0.05）.Conclusion PFNA has shorter operation time,and earlier postoperative ambulation time,good recovery of hip function .It also has smaller surgical trauma ,but not increase the incidence of postoperative complications in elderly patients with intertrochanteric femur fracture ,it＆#39;s worthy of promotion .