股骨近端防旋髓内钉与股骨近端解剖锁定钢板治疗老年股骨转子间骨折的比较研究  

A comparative study of proximal femoral nail anti-rotation and proximal femoral anatomic locking plate in the treatment of intertrochateric fracture

作　　者：李健[1] 黄海[1] 杨波[1] 潘永谦[1] 张平[1] 莫世奋[1] 

机构地区：[1]广州医学院第三附属医院骨科,广州510150

出　　处：《中国矫形外科杂志》2011年第18期1513-1516,共4页Orthopedic Journal of China

摘　　要：[目的]比较股骨近端防旋髓内钉(PFNA)和股骨近端解剖锁定钢板两种手术方法治疗股骨转子间骨折的疗效。[方法]对2004年3月～2009年9月收治的149例分别接受PFNA、解剖锁定钢板手术治疗的老年股骨转子间骨折患者资料进行回顾性分析。男58例,女91例;年龄67～96岁,平均(78.4±6.2)岁。骨折AO分型:A1型43例,A2型64例,A3型42例。其PFNA组86例,解剖锁定钢板组63例。对2组患者的术中情况、术后功能及并发症等情况进行比较。[结果]149例患者术后获12～36个月(平均22.6个月)随访,随访期间无死亡病例。PF-NA组手术切口长度较解剖锁定钢板组短,比较差异有统计学意义(P<0.05)。PFNA组、解剖锁定钢板组手术时间平均分别为(69.4±10.4)、(76.8±11.2)min,出血量平均分别为(162.2±46.5)、(210.5±80.2)ml,两组间比较差异均有统计学意义(P<0.05)。PFNA组平均住院天数、术后负重时间比解剖锁定钢板组短,比较差异有统计学意义(P<0.05),两种内固定术后骨折愈合时间及1年优良率比较差异无统计学意义(P>0.05)。[结论]PFNA、解剖锁定钢板有各自的优点和适应证,都是治疗股骨转子间骨折的好方法,PFNA组比解剖锁定钢板组手术切口小、时间短、出血少、下地行走时间早,对于不稳定性股骨粗隆间骨折的治疗更有优势,而严重骨质疏松的粉碎性骨折,可以选用解剖锁定钢板。[ Objective] To compare the clinical effect of proximal femoral nail anti-rotation（PFNA） and proximal femoral anatomic locking plate in the treatment of intertrochanteric fractures in the elderly patients. [ Method] From March 2004 to September 2009,149 old patients with intertrochanteric fractures were treated by either PFNA or anatomic locking plate, including 58 males and 91 females, with an average age of 78, 4 ± 6.2 years （ 67 - 96 years）. According to AO/ASIF classification, there were 43 patients with type 31 - A1 fractures ,64 patients with type 31 - A2 and 42 with 31 - A3. Eighty-six patients were treated with PFNA and 63 with anatomic locking plate. The operative procedures, therapeutic effects and complications were compared between 2 methods. [ Result] The patients included in the present study were followed up for 12 to 36 months（ average,22.6 months）. No deaths occurred during follow-up. PFNA group had smaller incision length than anatomic locking plate group, there were significant difference （ P 〈 0.05 ）. The operative time of PFNA, and anatomic locking plate group were （ 69.4 ± 10.4 ） , （ 76.8± 11.2 ） min ,the intraoperative blood loss of the two groups were （162.2 ± 46.5 ） , （210.5 ±80.2 ）ml, there were significant differences （ P 〈 0.05 ）. The length of hospital stay and walking time in PFNA group were shorter than those in anatomic locking plate group, there were significant differenees（P 〈0.05）. There were no significant differences in union time and the excellent rate one year postoperatively between the 2 groups. [ Conclusion] Each of them has its own advantages and indications. Both are effective ways to treat femoral intertrochanteric fractures. PFNA has smaller incision length, shorter operation time, less bleeding, and earlier walking than anatomic locking plate. PFNA has more advantages to treat unstable femoral intertrochanteric fractures. Anatomic locking plate is fit for the elderly patients with severe comminuted fractures and oste

关 键 词：股骨转子间 骨折 内固定术 股骨近端防旋髓内钉 解剖锁定钢板 

分 类 号：R687.3[医药卫生—骨科学]