摘要
[目的]比较股骨近端防旋髓内钉(PFNA)与动力髋螺钉(DHS)治疗股骨粗隆间骨折的临床效果。[方法] 2014年7月~2018年7月我院收治的股骨粗隆间骨折患者100例,根据随机数字表法将其分为PFNA组和DHS组各50例,PFNA组采用股骨近端防旋髓内钉内固定治疗,DHS组采用动力髋螺钉内固定治疗,比较2组临床资料。[结果]两组患者手术均顺利完成,术中未发血管、神经损伤等并发症。PFNA组在切口长度、手术时间、术中透视时间、术中出血量、下床活动时间均显著优于DHS组,差异有统计学意义(P<0.05)。PFNA组术后总体并发症发生率为10.0%(5/50),而DHS组为24.0%(12/50),两组差异有统计学意义(P<0.05)。至末次随访时,PFNA组2例,DHS组3例患者骨不连合并内固定物松动,均实施二期翻修手术。术后3、6、9个月时,PFNA组髋关节Harris评分均显著高于DHS组,差异有统计学意义(P<0.05)。影像方面,术后PFNA组50例中,解剖复位35例,功能复位12例,复位不良3例;DHS组50例中,解剖复位28例,功能复位17例,复位不良5例;两组间差异有统计学意义(P=0.009)。除骨不连患者外,其余患者骨折均愈合,PFNA组骨折愈合时间为(12.82±1.46)周,DHS组为(14.23±1.61)周,两组间差异有统计学意义(P<0.001)。[结论] PFNA固定临床治疗效果显著优于DHS固定,可使股骨粗隆骨折患者早期行康复训练,而DHS仅适合治疗稳定的股骨粗隆间骨折。
[Objective] To compare the clinical outcomes of proximal femoral nail anti-rotation(PFNA) versus dynamic hip screw(DHS) for femoral intertrochanteric fractures. [Methods] A total of 100 patients who were admitted into our hospital from July 2014 to July 2018 for femoral intertrochanteric fractures were enrolled into this study, and divided into two groups by random number table method with 50 patients in each group. The patients in the PFNA group had the fractures fixed by using PFNA, while those in the DHS group were by using DHS. The clinical data was compared between two groups. [Results] All the patients had surgical procedure performed smoothly without serious complications, such as neurovascular injuries. The PFNA group proved significantly superior to the DHS group regarding incision length, operation time, intraoperative fluoroscopy, blood loss and ambulation time(P<0.05). The total complication rate was of 10.0%(5/50) in the PFNA group, while 24.0%(12/50) in the DHS group, which proved statistically significant(P<0.05). To the latest follow up, 2 patients in the PFNA group and 3 patients in the DHS suffered from nonunion of fracture accompanied with loosening of the implants, which were treated by revision surgeries. The PFAN group was marked significantly higher Harris score than the DHS group at 3, 6 and 9 months postoperatively(P<0.05). In term of radiographic assessment, the reduction of intertrochanteric fractures was graded as anatomic reduction in 35, functional reduction in 12 and poor reduction in 3 of the PFNA group, whereas anatomic reduction in 28, functional reduction in 17 and poor reduction in 5 of the DHS group, which was statistically significant(P<0.05). Except the patients who suffered from nonunion, all the patients achieved bony healing of the fractures, with a mean healing time of(12.82±1.46) weeks in the PFNA group, whereas(14.23±1.61) weeks in the DHS group, which proved statistically significant(P<0.001).[Conclusion] The PFNA is superior to DHS in clinical outcomes, and has advantage of facilitating early rehabilitation training for intertrochanteric fractures, while DHS is only suitable for the stable intertrochanteric fracture.
作者
王炎
汪海滨
史法见
王斌
张磊
丁志勇
WANG Yan;WANG Hai-bin;SHI Fa-jian;WANG Bin;ZHANG Lei;DING Zhi-yong(Department of Orthopedics,Nanjing Jiangbei People's Hospital Affiliated to Nantong University,Nanjing 210048,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2019年第24期2223-2227,共5页
Orthopedic Journal of China
关键词
股骨粗隆间骨折
股骨近端防旋髓内钉
动力髋螺钉
内固定
intertrochanteric fracture
proximal femoral nail anti-rotation(PFNA)
dynamic hip screw(DHS)
inter-nal fixation
