外侧壁危险型股骨粗隆间骨折DHS与PFNA治疗的回顾性对比研究  

Extramedullary DHS and intramedullary PFNA in unstable pertrochanteric fractures with lateral wall risky AO/OTA type 31A2.2 and A2.3:a clinical retrospective comparison

作　　者：张世民[1] 祝晓忠[1] 黄轶刚[1] 王欣[1] 张英琪[1] 马卓[1] 

机构地区：[1]上海同济大学附属同济医院骨科,200065

出　　处：《中国矫形外科杂志》2010年第22期1868-1872,共5页Orthopedic Journal of China

摘　　要：[目的]比较髓外DHS(dynamic hip screw)与髓内PFNA(proximal femoral nail anti-rotation)治疗外侧壁危险型股骨粗隆间骨折的临床效果,并探讨术中或术后外侧壁破裂对功能恢复的影响。[方法]回顾性分析2007～2008年采用PFNA和2005～2006年采用DHS治疗的不稳定型顺向股骨粗隆间骨折,PFNA组71例(男19例,女52例,平均年龄77岁),DHS组62例(男24例,女38例,平均年龄75.5岁)。比较两组患者的基线状况,外侧壁骨折的发生率、术后康复进程和功能恢复情况,并对比DHS组外侧壁破裂对康复过程和功能效果的影响。[结果]两组患者在年龄、性别比、骨折前的基本日常生活能力(BADL)、步行活动能力、手术危险度分级、内科合并症数目、骨质疏松Sigh指数、术中骨折复位质量以及拉力螺钉的置放(TAD)等方面,均无明显统计学差别。PFNA组能早期下地负重行走(平均4.4周),较DHS组(平均10.6周)康复进程显著为快。但PFNA组的髋股部疼痛不适发生率(25%)较DHS组(11%)显著为高。DHS组有5例发生外侧壁破裂(占8%),虽经延长卧床时间(达3个月以上)等措施骨折均获得愈合,但其功能效果较无外侧壁破裂者显著为差。[结论]DHS治疗不稳定型顺向股骨粗隆间骨折有发生外侧壁破裂而导致失败的危险,建议采用头髓钉系统(如PFNA)固定。[Objective]To compare the clinical outcomes between dynamic hip screw（DHS） and proximal femoral nail anti-rotation（PFNA） in the treatment of unstable pertrochanteric fractures（AO/OTA type 31A2.2 and A2.3）,and to investigate the impact of intraoperative or postoperative lateral wall fracture on functional recovery.[Method]Retrospective analysis of two cohorts of patients treated with PFNA in 2007-2008（71 cases,19 men and 52 women,with mean age of 77 years） versus DHS in 2005-2006（62 cases,24 men and 38 women,with mean age of 75.5 years） was performed.The patient demographic data,incidence of lateral wall fracture,rehabilitation progress and functional recovery score were recorded and statistically compared.[Result]There were no statistical differences between PFNA and DHS treated groups in patient age,sex ratio,pre-fracture score of activity of daily living,walking ability score,ASA physical risk score,number of medical comorbidities,osteoporosis Sigh index,fracture reduction quality and the position of lag screw or helical blade in femoral head（TAD）.Patients in PFNA-treated group got ground-walking much earlier（mean,4.4 weeks） than those in DHS-treated group（mean,10.6 weeks）,but at 6 month follow-up,they（25%） reported more incidence of hip-thigh pain than those in DHS group（11%）.Five patients in DHS-treated group had lateral wall fracture during and after operation.Although the fracture healed after prolonged bed resting（3 months）,the functional outcome was much poorer than that in lateral wall intact patients.[Conclusion]For unstable pertrochanteric fractures fixed with DHS,risk of lateral wall fracture and treatment failure must be considered.Cephomedualary nail such as PFNA is recommended.

关 键 词：股骨粗隆间骨折 外侧壁 骨折内固定 DHS PFNA 髋股疼痛 功能效果 

分 类 号：R687.3[医药卫生—骨科学]