PFNA、PFN与DHS内固定治疗老年骨质疏松性股骨粗隆间骨折疗效对比  

Effect Comparison of PFNA,PFN and DHS Internal Fixation for Osteoporotic Intertrochanteric Fracture in Elderly

作　　者：宋建治[1] 肖少雄[1] 徐礼森[1] 

机构地区：[1]湖北省武汉市第一医院骨科,武汉430022

出　　处：《中国现代手术学杂志》2012年第4期305-308,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的比较应用股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)、股骨近端髓内钉(proximal femoral nail,PFN)及动力髋螺钉(dynamic hip screw,DHS)治疗老年骨质疏松性股骨粗隆间骨折的疗效。方法选择我科2007年6月～2011年6月收治的骨质疏松性股骨粗隆间骨折患者176例,采用PFNA内固定治疗68例(PFNA组),应用PFN内固定治疗62例(PFN组),应用DHS内固定治疗46例(DHS组),比较三组的手术时间、术中出血量、骨折愈合时间、术后并发症、Harris髋关节评分。结果所有患者均获随访,平均19(12～26)月。PFNA组与PFN、DHS组相比,手术时间缩短、术中出血量少,骨折愈合时间短,差异有统计学意义(P<0.05);术后三组Harris髋关节功能评分比较,C组较差(P<0.05)。术后并发症比较三组无显著性差异(P>0.05)。结论与PFN及DHS相比,PFNA内固定治疗股骨粗隆间骨折具有操作简单、创伤小、固定牢固、防旋转,是治疗股骨粗隆间骨折的理想方法之一,有利于骨折稳定以及早期进行功能锻炼,其治疗效果明显优于DHS与PFN内固定,尤适用于老年骨质疏松性股骨粗隆间骨折。Objective To compare the effects of internal fixation of proximal femoral nail anti-rotation （ PFNA）, proximal femoral interlocking nail （PFN） and dynamic hip screw （ DHS ） for osteoporotic intertrochanteric fracture in elderly. Methods A total of 176 aged patients of osteoporotic intertrochanteric fracture, with aged 62 to 98 years, admitted from June 2007 to June 2011 were retrospectively analyzed. Among them, 68 eases were performed PFNA internal fixation （ as PFNA group） , 62 were PFN （ as PFN group） and 46 were DHS （as DHS group）. The operative duration, intraoperative blood loss, fracture healing time, postoperative complication and Harris hip score were compared among three groups. Results All cases were followed up for 12 to 26 months with an average of 19 months. Compared with group PFN and group DHS, the operative duration and fracture healing time were shorter and intraoperative blood loss was less in group PFNA, and there was significantly difference （ P 〈 0. 05 ）. Harris hip score of group DHS was lower than that of group PFNA and group PFN （P 〈 0.05 ）, but there was no significant difference in postoperative complication （ P 〉0. 05 ）. Conclusion Compared with internal fixation of PFN and DHS, PFNA fixation is a simple, mini-traumatic and effective treatment with advantage as firm internal fixation, reliable anti-rotation and benefit of fracture stability and early function exercise, and it is an ideal internal fixation for osteoporotic intertrochanterie fracture in elderly.

关 键 词：髋骨折 骨折固定术 内 骨质疏松 内固定器 

分 类 号：R687.3[医药卫生—骨科学]