DHS和PFNA内固定治疗高龄股骨粗隆间骨折疗效分析.docVIP

DHS和PFNA内固定治疗高龄股骨粗隆间骨折疗效分析 　　【摘要】 目的：回顾性分析动力髋螺钉（DHS）和股骨近端抗旋髓内钉（PFNA）治疗高龄股骨粗隆间骨折的临床疗效。方法：收集2006年1月-2013年1月期间，因股骨粗隆间骨折接受DHS或PFNA内固定手术者223例，其中DHS组121例，PFNA组102例。对比分析两组患者性别、年龄、手术时间、术中失血量、隐性失血量、卧床时间、住院时间、并发症发生率、术后骨折愈合时间、术后髋关节功能评分等。结果：两组患者在年龄、性别、骨折类型方面比较差异均无统计学意义。术后随访12～20个月，DHS组中有11例内固定失败或不愈合，PFNA组有3例发生不愈合或延迟愈合。PFNA组较DHS组手术时间短，术中出血少，骨折愈合时间短，术后并发症发生率低，术后髋关节Harris评分高，但术后隐性失血多（P0.05）。两组术后卧床时间、住院时间、总失血量比较差异无统计学意义。结论：DHS和PFNA治疗股骨粗隆间骨折都可以获得良好效果。然而PFNA较DHS创伤小、术后并发症少、术后髋关节功能恢复好，适用于各种类型尤其是不稳定型股骨粗隆间骨折或严重骨质疏松患者，是一种理想的内固定方式。 　　【关键词】 高龄股骨粗隆间骨折； 动力髋螺钉； 股骨近端抗旋髓内钉； 疗效 　　【Abstract】 Objective：To compare the clinical effect in patients who underwent operation for intrertochanteric femoral fractures using dynamic hip screw（DHS） versus proximal femoral nail antirotation（PFNA）.Method：A retrospective study of 223 patients with intertrochanteric fractures who received a DHS or a PFNA from Jan 2002 to Jan 2013 were undertook.There were 121 patients in DHS group， whereas 102 patients in PFNA group.The age， sex distribution， duration of operation， blood loss， bedridden time， duration of hospitalization， rate of complications， time to union， harris hip joint functional score were recorded and assessed.Result：The patients got followed up for 12 to 20 months.No difference was found between two groups in age，sex distributions and type of fracture.Statistically significant differences were found in operation time，fracture union time，rate of complications，and harris hip joint functional score between the two groups（P0.05）.There were no significant difference in bedridden time，duration of hospitalization and total blood loss.Conclusion：DHS and PFNA can treat intertrochanteric fractures with good result.PFNA is superior to DHS in less invasive， reducing complication rates，recovering hip joint function；it is an ideal fixation method for treating all type of intertrochanteric fracture especially for unstable femoral intertrochanteric fracture and patients with severe osteoporotic. 　　【Key words】 Femoral