摘要
目的比较股骨近端抗旋髓内钉(PFNA)与动力髋螺钉(DHS)两种方法内固定治疗高龄股骨粗隆间骨折的疗效。方法 2007年1月-2011年1月分别采用PFNA、DHS治疗高龄股骨间粗隆骨折(EvansⅠ～Ⅳ型)共68例,其中PFNA组36例,平均年龄81.5岁;DHS组32例,平均年龄82.3岁。两组患者在年龄、性别、骨折分型、合并症以及受伤至手术时间方面比较差异均无统计学意义(P>0.05),有可比性。结果术后68例患者均获随访,随访时间6～26个月。与DHS组比较,PFNA组手术时间短、术中出血少,差异有统计学意义(P<0.05);PFNA组骨性愈合时间短,但两组差异无统计学意义(P>0.05)。术后DHS组出现1例髋内翻、1例拉力螺钉切出股骨头颈,PFNA组出现1例主钉退钉,两组术后并发症发生率比较差异有统计学意义(P<0.01)。术后1年PFNA组髋关节Harris评分显著高于DHS组,差异有统计学意义(P<0.01)。结论 PFNA与DHS两种固定方法的骨性愈合时间短、术后并发症少、髋关节功能恢复好,是治疗股骨粗隆间骨折的良好方式,尤其是PFNA能减少手术时间和术中出血量,手术创伤小,对高龄且不能耐受较大手术者可作为一种首选术式。
Objective To compare the effectiveness of proximal femoral nail antirotation（PFNA） and dynamic hip screw（DHS） in the treatment of elderly femoral intertrochanteric fractures.Methods From January 2007 to January 2011,we used PFNA and DHS to treat 68 cases of senile femoral intertrochanteric fractures（Evans between ⅠtoⅣ）,including 36 cases PFNA treatment and 32 of DHS.The average age of the patients was 82.3 years old.There were no significant differences between the two groups of patients in age,sex,fracture type,comorbidities and operation time from injury to treatment（P0.05）,though there was comparability.Results All 68 patients were followed up for 6 to 26 months.Compared with the DHS group,PFNA group had significantly shorter operation time and less bleeding（P0.05）.PFNA group bony healing time was short,but it had no significant difference between the two groups（P0.05）.After surgery,DHS group had one case of coxa vara,and one case of lag screw cut-out from the femoral head and neck,and PFNA group had one case of main nail withdrawing.The two groups were significantly different in postoperative complication rate（P0.01）.One year after surgery,PFNA group Harris hip score was significantly higher than that of the DHS group with a statistically significant difference（P0.01）.Conclusions The two fixation methods of PFNA and DHS are both effective in the treatment of intertrochanteric fractures for their short bone healing time,few postoperative complications,and good functional recovery of the hip joint.Especially,PFNA is the best choice for aged patients who can not bear larger operations for the advantages of reducing operation time and the amount of bleeding during operation,and small operation injury.
出处
《华西医学》
CAS
2012年第12期1840-1843,共4页
West China Medical Journal
关键词
高龄
粗隆间骨折
股骨近端抗旋髓内钉
动力髋螺钉
Elderly
Intertrochanteric fracture
Proximal femoral nail anti-rotation
Dynamic hip screw
