两种不同内固定方式治疗股骨粗隆间骨折对比研究  

A Clinical Comparison of Two Methods of Internal Fixation of Intertrochanteric Fractures

作　　者：倪晓辉[1] 朱兴元[1] 田顺林[1] 刘晓冬[1] 张卢[1] 

机构地区：[1]江苏省大丰市人民医院骨科,江苏大丰224100

出　　处：《实用骨科杂志》2014年第10期888-891,共4页Journal of Practical Orthopaedics

基　　金：盐城市科技计划项目(YK20100054)

摘　　要：目的探讨股骨近端抗旋髓内钉(proximal femoral nail anti-rotation,PFNA)和动力髋螺钉(dynamic hip screw,DHS)治疗老年人股骨粗隆间骨折的临床疗效。方法对2008年1月至2011年1月41例老年股骨粗隆间骨折患者的临床资料及手术结果进行回顾性分析,其中PFNA组17例,DHS组24例。对两组患者的一般资料、手术时间、术中出血量、骨折平均愈合时间、负重时间、髋关节功能恢复情况等进行统计学分析。结果 PFNA组较DHS组平均手术时间短(t=2.704,P=0.018),术中出血少(t=5.009,P=0.006),术后负重时间早(t=2.899,P=0.017),以及术后骨折复位丢失、髋内翻畸形率低(χ2=4.490,P=0.039)。髋关节功能按Harris评分标准进行评价,PFNA组优8例,良7例,可1例,差1例,优良率88.2%;DHS组优9例,良6例,可5例,差4例,优良率62.5%;两组差异有统计学意义(χ2=4.042,P=0.047)。两组在术后骨折愈合时间方面差异无统计学意义(P>0.05)。结论 PFNA治疗股骨粗隆间骨折具有微创、固定牢稳、术后可进行早期功能锻炼、并发症少等优点,是治疗老年人股骨粗隆间骨折的理想方法 。Objective To compare the clinical results of PFNA fixation and DHS fixation of intertrochanteric fractures.Methods Seventeen patients who had received PFNA fixation and 24 ones who had DHS fixation of intertrochanteric fractures in our hospital between January 2008 to January 2011 were involved in our retrospective investigation.The clinic data,operation time,intraoperative blood loss,fracture healing time,postoperative weight loading time,functions of the hip joint of the 2 groups were all statistically compared in our study.Results The average operation time of PFNA fixation group was shorter than DHS fixation group（ t = 2.704,P = 0.018）,and the blood loss was lesser（ t = 5.009,P = 0.006）,the postoperative weight loading time was earlier（ t = 2.8 9 9,P = 0.0 1 7）,the incidence of dislocation of fracture or hip varus was lower（ χ^2= 4.4 9 0,P =0.039）.According to Harris standard,PFNA fixation group were excellent in 8 cases,good in 7 cases,fair in 1cases and poor in 1 case,the rate of excellent and good was 88.2%,while DHS fixation group were excellent in 9 cases,good in 6 cases,fair in 5 cases and poor in 4 case,the rate of excellent and good was 62.5 %,and there was a significant difference（ χ^2= 4.042,P = 0.047）.There was no significant difference between the 2 groups in the fracture healing time（ P〉0.05）.Conclusion PFNA fixation of intertrochanteric fractures is a treatment of elder patients with intertrochanteric fractures as a good way.

关 键 词：股骨粗隆间骨折 股骨近端抗旋髓内钉 动力髋螺钉 对比 

分 类 号：R683.42[医药卫生—骨科学]