股骨粗隆间骨折不同内固定治疗效果、安全性及患者关节功能情况对比观察

目的观察股骨近端抗旋髓内钉(PFNA)、动力髋螺钉(DHS)、股骨近端解剖锁定钢板(ALP)三种内固定方法在股骨粗隆间骨折治疗中的应用效果及关节功能情况。方法将2013年12月—2016年12月期间在北京市垂杨柳医院行股骨粗隆间骨折内固定术的96例患者根据随机数字表法分为三组,包括PFNA组、DHS组、ALP组,每组32例。回顾性分析所有患者的临床资料,比较3种内固定术的术中和术后情况、术后并发症情况及髋关节功能Harris评分情况。结果与PFNA组比较,DHS组和ALP组患者的手术时间、出血量、切口长度、术后引流量及卧床时间明显较多(P0.01),但3组患者术后的骨折愈合时间差异无统计学意义(P0.05);3组患者均出现内固定物断裂、螺钉拔出、肢体缩短、延期愈合、肺部感染及血栓形成等并发症,但PFNA组未出现髋内翻的情况;DHS组患者的术后总并发症发生率高于PFNA组和ALP组(P0.05);PFNA组患者术后髋关节功能Harris评分优良率为90.6%,略高于DHS组和ALP组的87.5%,但差异无统计学意义(P0.05)。结论 PFNA、DHS、ALP 3种内固定术均有效地治疗股骨粗隆间骨折,各有一定优势。

Comparison of treatment effect,safety and joint function of patients with intertrochanteric fractures with different internal fixation

Objective To observe the effect and joint function of proximal femoral intramedullary nail(PF-NA),dynamic hip screw(DHS)and proximal femoral anatomic locking plate(ALP)internal fixations in the treat-ment of intertrochanteric fractures.Methods A total of 96 patients who adopted internal fixation for intertrochan-teric fractures in our hospital from Dec.2013 to Dec.2016 were divided into three groups according to the internal fixation method,with 32 patients in each group.The clinical data of all patients were retrospectively analyzed,and in-traoperative and postoperative situation,postoperative complications and Harris scores of three groups were com-pared.Results Compared with the PFNA group,the operation time,blood loss,length of incision,postoperative drainage and bed time of the DHS group and the ALP group were significantly more(P<0.01),but the difference of postoperative fracture healing time of the three groups was not statistically significant(P>0.05).All three groups developed complications like fixation brakage,screw extraction,extremity shortening and delayed union,but PFNA group did not develop coxa vara.The postoperative complication rate of the DHS group was more than that of the PF-NA group and the ALP group(P<0.05).The excellent and good rate of hip joint function evaluated by Harris score of the PFNA group was 90.6%,which was slightly more than 87.5%of the DHS group and the ALP group,but the difference was not statistically significant(P>0.05).Conclusion PFNA,DHS and ALP internal fixations can treat intertrochanteric fracture effectively,and each has its advantages.