防旋型股骨近端髓内钉与动力髋螺钉治疗骨质疏松性股骨近端骨折疗效比较  

PFNA versus DHS for osteoporotic fractures of the proximal femur

作　　者：刘君[1] 刘兴邦[1] 

机构地区：[1]潜江市中心医院骨科,湖北433100

出　　处：《社区医学杂志》2014年第3期1-3,共3页Journal Of Community Medicine

摘　　要：目的比较防旋型股骨近端髓内钉（proximal femoral nail antirotation，PFNA）与动力髋螺钉（dynamichipscrews，DHS）治疗骨质疏松性股骨近端骨折的临床效果。方法选择2008年1月-2012年1月收治的骨质疏松性股骨近端骨折患者60例，随机分为PFNA组和DHS组各30例，采用全身麻醉或腰硬联合麻醉，取仰卧位，患侧臀下垫一软枕，患肢伸直，内收15°，内旋15°。用牵引床维持牵引，C型臂X线机监视下闭合复位，并维持牵引固定。PFNA组选择合适直径的PFNA主钉沿导针插入牙腔。DHS组复位满意后切开大粗隆外侧，C型臂X线机引导下定位插入导针，旋入拉力螺钉，安装带套筒钢板，螺钉固定。常规放置负压引流管逐层关闭切口。两组术后常规应用抗生素3d预防感染，给予止痛、抗骨质疏松、活血化瘀等治疗。术后第1天鼓励行股四头肌等长收缩训练，第3天后予以连续被动运动仪（continuous passive motion，CPM）辅助训练，第7天后扶拐下地活动，患肢逐渐负重行走。比较两组手术时间、术中出血量、骨折愈合时间、术后髋关节Harris功能评分、术后并发症发生情况及复位质量。计量资料采用t检验，计数资料采用矿检验，P〈0．05为差异有统计学意义。结果PFNA组手术时间、术中出血量、骨折愈合时间及术后髋关节Harris功能评分[（76．5±31．6）min、（278．8±40．1）ml、（10．4±0.4）周、（89．3±0．7）分]与DHS组[（104．3±27．9）min、（456．3±36．4）ml、（13．1±0．2）周、（72．1±0．5）分]比较差异均有统计学意义（均P〈0．05）。随访时间15～30个月，平均24个月，住院期间无死亡病例，随访中DHS组有1例死于其他系统疾病。优良率PFNA组93．3％，DHS组73．3％，比较差异有统计学意义（P〈0．05）。结论对于骨质疏松性股骨近端骨折，PFNA较DHS更符合股骨近端生物力学特点，能取得更有Objective To compared the clinical efficacy of proximal femoral nail antirotation（PFNA） and dynamic hip screws（DHS） for osteoporotic fractures of the proximal femur.Methods A total of 60 cases of osteoporotic fracture of the proximal femur treat-ed from January 2008 to January 2012 were randomized into PFNA group and DHS group,30 cases for each group.General anes- thesia or combined spinal-epidural anesthesia was performed,during which the patients were in supine position,with a soft pillow placed below the affected hip,and the affected limb had to be extended with adduction and internal rotation at 15 degrees.Traction bed was used;closed reduction was conducted under the guidance of C-arm X-ray machine.In PFNA group,PFNA nails of appro-priate diameter were inserted into marrow cavity.After a successful reduction,the lateral aspect of the greater trochanter was in- cised,needle guides were inserted under the guidance of C-arm X-ray machine,lag screws were placed,and sleeve steel plates were installed.A suction drainage tube was placed conventionally and wounds were closed layerly afterwards.Postoperative antibi- otics were given to both groups for 3days to prevent infection,as well as analgesie,anti-osteoporosis treatment,and herbs for invigo- rating blood and dissolving stasis.The patients were encouraged to have isometric quadriceps training on dl after surgery and auxiliary training of continuous passive motion on d3 after surgery,and to ambulate with crutches on d7 after surgery,and gradually they could walk with partial weight-bearing on the affected limb.Both groups were compared for the duration of operation,intraop-erative blood loss,time of fracture healing, postoperative Harris hip scores and complications,and reduction.Measurement data were processed by t-test,count data by X^2 test,the result of P〈0,05 was considered statistically significant.Results The duration of op- eration,intraoperative blood loss,time of fracture healing, postoperative Harris hip scores were （76.5 ± 31.6）min,（2

关 键 词：骨质疏松性股骨近端骨折 防旋型股骨近端髓内钉 动力髋螺钉 骨折 

分 类 号：R683[医药卫生—骨科学]