防旋股骨近端髓内钉与动力髋螺钉治疗外侧壁危险型股骨粗隆间骨折的疗效比较

Treatment effects of proximal femoral nail antirotation and dynamic hip screw on dangerous lateral wall intertrochanteric fractures

关键词:  股骨粗隆间骨折  外侧壁  防旋股骨近端髓内钉  动力髋螺钉

Key words:  intertrochanteric fractures  the lateral femoral wall  proximal femoral nail antirotation  dynamic hip screw

摘要:

目的　探讨防旋股骨近端髓内钉（proximal femoral nail antirotation，PFNA）与动力髋螺钉（dynamic hip screw,DHS）治疗外侧壁危险型股骨粗隆间骨折的临床效果。　方法　回顾性分析2009年11月至2015年11月沈阳医学院附属中心医院收治的72例外侧壁危险型股骨粗隆间骨折患者的临床资料。按手术固定方法分为PFNA组38例（AO31-A2.2型19例，AO31-A2.3型19例）及DHS组34例（AO31-A2.2型18例，AO31-A2.3型16例）。术前测量X线片上的外侧壁厚度值后，比较两组患者的手术时间、术中出血量、住院天数及术中、术后有无并发外侧壁骨折。采用老年髋部骨折功能恢复量表（FRS）对术后疗效进行评估。　结果　PFNA组手术时间、术中出血量、住院天数均低于DHS组，差异有显著性意义（P＜0.05）。PFNA组术中4例并发外侧壁骨折，术后5例并发外侧壁骨折；DHS组术中10例并发外侧壁骨折，术后7例并发外侧壁骨折。56例患者获得随访，随访时间6~20个月，平均12个月。随访1年以上者50例，FRS评分：PFNA组（77.5±7.9）分，DHS组(69.3±4.8)分，差异有显著性意义（P＜0.05）。　结论　治疗外侧壁危险型股骨粗隆间骨折，PFNA的手术效果及患者髋部功能恢复情况，均明显优于DHS。

Abstract:

Objective To evaluate the effects of proximal femoral nail antirotation (PFNA) and dynamic hip screw (DHS) on dangerous lateral wall intertrochanteric fractures. 　Methods From November 2009 to November 2015, 72 patients with dangerous lateral wall intertrochanteric fractures were treated with PFNA and DHS. The group PFNA included 38 cases and the group DHS included other 34 cases. According to the AO/OTA classification, there were 19 cases in AO31-A2.2, 19 in AO31-A2.3.1 in group PFNA, and 18 in AO31-A2.2, 16 in AO31-A2.3 in group DHS. The data of lateral femoral wall thickness in preoperative X-ray, operative time, operative blood loss, average length of hospital stay, and secondary fracture of lateral femoral wall were collected for each patient. Clinical evaluation was made using the functional recovery scale (FRS) of hip fracture. 　Results The mean operative time, operative blood loss, average length of hospital stay in group PFNA were less than those in group DHS. Secondary fracture of lateral femoral wall occurred in 9 cases in group PFNA and 17 in group DHS. 54 cases were followed up for 6-20 months (mean 12 months). 50 cases were followed up for one year. The mean FRS score was （77.5±7.9）points in group PFNA and （69.3±4.8） points in group DHS. 　Conclusion It is better to use PFNA than DHS in treating dangerous lateral wall intertrochanteric fractures.