经皮撬拨复位联合PNFA治疗与DHS治疗老年股骨转子间骨折临床疗效比较

Comparison of the Effects of Proximal Femoral Nail Antirotation and Dynamic Hip Screw in Treatment of Elderly Intertrochanteric Fractures

摘要: 目的：经皮撬拨复位股骨近端防旋髓内钉(Proximal femoral nail antirotation, PFNA)与动力髋螺钉(Power hip screw, DHS)内固定术治疗老年股骨转子间骨折的临床疗效，为临床选择围手术期处理方式提供数据支撑。方法：回顾性分析我院骨科2015年1月至2019年3月收治且获得完整随访的98例老年股骨转子间骨折患者资料，其中PFNA组53例，DHS组45例。分别对两组患者围术期指标、髋关节功能、固定效果及手术前、后生活活动能力进行观察，并进行相关分析。结果：PFNA组术中失血量、切口长度、骨折愈合时间、术后负重时间与DHS组对比差异有统计学意义(P < 0.05)；PFNA组术后6个月髋关节功能优良率为88.68%，与DHS组73.33%对比，明显较高(P < 0.05)；PFNA组术后髋内翻、股骨头切割、内固定失效总发生率为3.77%，与DHS组20.00%对比，差异有统计学意义(P < 0.05)；两组术前Barthel指数评分量表(BI)评分、功能独立性评价量表(FIM)评分对比差异无统计学意义(P > 0.05)，PFNA组术后6个月BI评分和FIM与同期DHS组对比，明显较高(P < 0.05)。结论：PFNA固定术治疗老年股骨转子间可取得理想固定效果，早期下地负重训练，且能促进髋关节功能恢复，改善患者生活活动能力，值得临床推广。

Abstract: Objective: To explore the effect of internal fixations for elderly intertrochanteric fractures: proximal femoral nail antirotation (PFNA) versus dynamic hip screw (DHS) to provide the data support for clinical perioperative management. Methods: 98 elderly patients with intertrochan-teric fracture treated in our hospital from January 2015 to March 2018 were divided into the control group with 45 cases treated with dynamic hip screw (DHS) internal fixation and the ob-servation group with 53 cases treated with percutaneous pry-pull reduction and PFNA fixation. The perioperative indexes, hip joint function, fixation effect and the ability of life activities be-fore and after operation were observed. Results: There were significant differences in blood loss in operation, incision length, fracture healing time and weight-bearing time between the observation group and the control group (P < 0.05). The excellent and good rate of hip function in the observation group was 88.68% on 6 months after operation, which was significantly higher than that of the control group (73.33%, P < 0.05). The total incidence of hip varus, femo-ral head incision and the failure of internal fixation in the dynamic hip screw group was 20.00%, which was higher than that in the PFNA group (P < 0.05). There was no significant difference in the scores of Barthel Index Scale (BI) and Functional Independence Assessment Scale (FIM) be-fore operation between the two groups (P > 0.05). The scores of BI and FIM of the observation group were significantly higher than those of the control group 6 months after operation (P < 0.05). Conclusion: The treatment of percutaneous prying reduction and PFNA fixation in the treatment of unstable intertrochanteric femur can achieve ideal fixation effect, and can promote the recovery of hip joint function and improve living activity ability of patients, which is worthy of clinical promotion.