动力髋螺钉加子钉与股骨近端防旋髓内钉治疗老年股骨转子间A2型骨折的对比研究  

A retrospective trial of dynamic hip screw fixation combined with auxiliary screw fixation versus proximal femoral nail antirotation fixation for type A2 intertrochanteric fractures in old patients

作　　者：万超[1] 邹季[1] 朱小虎[2] 

机构地区：[1]湖北中医药大学,湖北武汉430061 [2]湖北医药学院附属太和医院,湖北十堰442000

出　　处：《中医正骨》2013年第7期24-27,共4页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:比较动力髋螺钉加子钉固定与股骨近端防旋髓内钉固定治疗老年股骨转子间A2型骨折的临床疗效和安全性。方法:回顾性分析接受手术治疗的70例老年股骨转子间A2型骨折患者的临床资料,采用动力髋螺钉加子钉固定者37例(DHS组),采用股骨近端防旋髓内钉固定者33例(PFNA组)。比较2组患者的切口长度、手术时间、术中出血量、术后引流量、住院时间、骨折愈合时间、术后12个月随访时的d’Aubigné-Postel髋关节评分及并发症发生率。结果:①一般情况。2组患者均获随访,时间12～24个月,中位数16.5个月。PFNA组患者的切口长度、手术时间、术中出血量及术后引流量均少于DHS组[(13.80±1.90)cm,(22.50±1.60)cm,t=20.792,P=0.000;(60.40±16.50)min,(77.20±15.50)min,t=4.391,P=0.000;(223.50±110.70)mL,(347.80±120.60)mL,t=4.474,P=0.000;(87.20±46.40)mL,(227.50±50.80)mL,t=12.013,P=0.000];PFNA组患者的住院时间及骨折愈合时间与DHS组比较,差异无统计学意义[(19.50±3.20)d,(20.00±3.10)d,t=0.663,P=0.510;(3.20±2.10)个月,(3.30±2.30)个月,t=0.189,P=0.851]。②髋关节功能。DHS组优17例,良12例,中6例,差2例;PFNA组优15例,良13例,中4例,差1例。2组患者髋关节功能比较,差异无统计学意义(U=0.346,P=0.910)。③并发症。DHS组6例发生股骨颈短缩,8例发生髋内翻,PFNA组1例发生髋内翻。2组患者均未发生感染及静脉血栓栓塞。DHS组患者的并发症发生率高于PFNA组(χ2=12.552,P=0.000)。结论:动力髋螺钉加子钉固定与股骨近端防旋髓内钉固定治疗老年股骨转子间A2型骨折疗效相当,但后者具有创伤小、手术时间短及并发症少的优势。Objective：To compare the clinical curative effects and safety of dynamic hip screw（DHS）fixation combined with auxiliary screw fixation with those of proximal femoral nail antirotation（PFNA）fixation for type A2 intertrochanteric fractures in old patients.Methods：The clinical records of 70 old patients who underwent operative treatment for type A2 intertrochanteric fractures were analyzed retrospectively.Thirty-seven patients（DHS group）were administrated with DHS fixation combined with auxiliary screw fixation,while the others（PFNA group）were administrated with PFNA fixation.The two groups were compared with each other in such parameters as incision length,operative time,blood loss,postoperative drainage,hospital stay,fracture healing time,d＇Aubigné-Postel hip scores at 12 months after operation and incidence rate of complications.Results：The patients in the 2 groups were all followed up for 12-24 months with a median of 16.5 months.The incision length,operative time,blood loss and postoperative drainage of PFNA group were all lower than those of DHS group[（13.80±1.90）cm vs（22.50±1.60）cm,t=20.792,P=0.000;（60.40±16.50）min vs（77.20±15.50）min,t=4.391,P=0.000;（223.50±110.70）mL vs（347.80±120.60）mL,t=4.474,P=0.000;（87.20±46.40）mL vs（227.50±50.80）mL,t=12.013,P=0.000].There were no statistical differences in hospital stay and fracture healing time between PFNA group and DHS group[（19.50±3.20）d vs（20.00±3.10）d,t=0.663,P=0.510;（3.20±2.10）months vs（3.30±2.30）months,t=0.189,P=0.851].Seventeen patients obtained an excellent result,12 good,6 fair and 2 poor in DHS group;while 15 patients obtained an excellent result,13 good,4 fair and 1 poor in PFNA group.There was no statistical difference in hip function between the 2 groups（U=0.346,P=0.910）.Six patients with femoral neck shortening,8 cases with coxa vara were found in DHS group,while 1 case with coxa vara was found in PFNA group.No patients with infection and venous thromboembolism were f

关 键 词：髋骨折 老年人 骨折固定术 内 治疗 临床研究性 动力髋螺钉股骨近端防旋髓内钉 

分 类 号：R687.3[医药卫生—骨科学]