老年不稳定性股骨粗隆间骨折内固定治疗方法选择

Selection of Internal Fixation for Unstable Intertrochanteric Fracture in Elderly Patients

摘要: 目的：通过评估股骨近端防旋髓内钉(PFNA)和动力髋螺钉(DHS)两种外科技术治疗老年不稳定型股骨粗隆间骨折，来选择适宜的内固定方法，以及如何确保该病人得到最好治疗。方法：回顾性分析我院创伤骨科85例老年不稳定型股骨粗隆间骨折患者，其中，43例PFNA治疗，42例DHS治疗，分别从术中时长、出血量、切口长度以及术后功能锻炼恢复时长进行详细记录并评估，以确保统计其术后髋关节功能的恢复效果。结果：85例患者中，随访6~16个月(平均11.6个月)，无死亡病例。PFNA组与DHS组在手术切口长度、术中时长、出血量、术后功能锻炼恢复时长方面有统计学差异(P < 0.05)，在骨折愈合时间、并发症发生率上亦有统计学差异(P < 0.05)。在髋关节功能恢复程度上，PFNA组优良率为46.5%，较DHS组45.2％稍高，没有明显差异(P > 0.05)。结论：本研究发现老年不稳定型股骨粗隆间骨折，髓内PFNA固定较髓外DHS固定具有更好的临床疗效。

Abstract: Objective: Proximal femoral nail antirotation nail (PFNA) and dynamic hip screw (DHS) were two kinds of surgical procedures. Treatment of unstable intertrochanteric fractures in the elderly through the two surgical procedures, we can select the appropriate method of internal fixation. Methods: Through retrospective analysis of 85 elderly patients with unstable intertrochanteric fracture in trauma department of orthopedics of our hospital, 43 cases were treated with PFNA in-ternal fixation, 42 cases of DHS served as control group. PFNA group and DHS group were compared from 6 aspects, such as, the length of incision, the time of operation, amount of bleeding from surgi-cal operation, postoperative rehabilitation exercise time, functional recovery of hip joint and frac-ture healing time. Results: 85 patients were followed up for 6~16 months (mean 11.6 months) without death. There was statistical difference between group PFNA and group DHS (P < 0.05) among the length of incision, the time of operation, the amount of bleeding and the time of rehabil-itation exercises. There was also statistical difference in the time of fracture healing and the inci-dence of complications (P < 0.05). The excellent and good rate of group PFNA was 46.5%, which was higher than that of group DHS (45.2%). There was no significant difference in the functional recov-ery of the hip joint (P > 0.05). Conclusions: This study has found that for unstable intertrochanteric fractures in elderly patients, intramedullary PFNA fixation has better clinical efficacy than ex-tramedullary DHS fixation.