老年股骨粗隆间粉碎性骨折的手术治疗及疗效观察

目的探讨传统动力髋螺钉（DHS）、股骨近端锁定加压钢板（PFLCP）、股骨近端防旋髓内钉（PFNA）治疗老年股骨粗隆间粉碎性骨折的临床疗效。方法61例老年股骨粗隆间粉碎性骨折患者进行内固定手术治疗，其中DHS组14例，PFLCP组23例，PFNA组24例，比较手术切口长度、手术时间、术中出血量、愈合时间、手术优良率和并发症发生率。结果①PFNA组切口长度短、手术时间和术中出血量少、手术优良率（79．1％）高于DHS组（71．4％），比较差异有统计学意义（P〈0．05）。②PFLCP组手术时间和术中出血量少、手术优良率（82．6％）高于DHS组，比较差异有统计学意义（P〈0．05）。③PFLCP组术后并发症发生率（8．7％）低于于PFNA组（16．7％）和DHS组（14．3％），比较差异有统计学意义（P〈0．05）。结论在治疗老年股骨粗隆间粉碎性骨折时，PFNA和PFLCP优于DHS，可以明显缩短手术时间和减少患者出血量。PFLCP固定术可降低患者固定失败等并发症发生率。

Study on clinical efficacy of surgical treatment on elderly patients with intertrochanteric comminuted fracture

Objective To study the curative effects of conventional dynamic hip screw （DHS）, proximal femoral locking compression plate （PFLCP） and proximal femoral nail antirotation （PFNA） in the treatment of elderly patients with intertrochanteric comminuted fracture. Methods 61 cases of patients with intertrochanteric comminuted fracture were internally fixed with surgical treatment. DHS group contained 14 cases. PFLCP group contained 23 cases. PFNA group contained 24 cases. The surgical incision length, operation time, bleeding volume, healing time, the ratio of excellent operation and the incidence rate of complications were compared. Results （1）The incision length and the operation time of PFNA group were shorter than those of DHS group, besides, the bleeding volume was less and the ratio of excellent operation was higher （79.1%v.s.71.4%, P〈0.05）. （2） The operation time of PFNA group was shorter than that of DHS group, besides, the bleeding volume was less and the ratio of excellent operation was higher （82.6% v.s.71.4%, P〈0.05）. （3） The incidence rate of complications in PFLCP group （ 8.7% ） was lower than those in DHS group （ 14.3% ） and PFNA group （16.7%, P〈0.05）. Conclusion PFNA and PFLCP are better than DHS in the treatment of senile comminuted femoral intertroehanteric fracture, because they can significantly shorten the surgical time and reduce the bleeding. PFLCP can reduce the incidence of complications such as the failure of fixation.