动力髋螺钉（DHS）与股骨近端髓内钉（PFN）手术治疗股骨粗隆间骨折方法比较
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摘要
目的：股骨粗隆间骨折是一种常发生于老年人的髋部骨折。据统计，北美每年有超过22000例髋部骨折造成了近90亿美元的医疗费用。随着社会人口的老龄化以及交通伤的逐年的增加，股骨粗隆间骨折的发病率有所增高。由于保守治疗可引起多种疾病的发生，股骨粗隆间骨折的坚固内固定可使患者早期活动，现被认为是标准的治疗方法。目前治疗股骨粗隆间骨折常用的两种内固定系统是以动力髋螺钉(DHS)为代表的髓外固定系统和以股骨近端髓内钉(PFN)的髓内固定系统。通过回顾性分析股骨粗隆间骨折的手术效果，比较DHS与PFN在治疗股骨粗隆间骨折的疗效。探讨DHS与PFN这两种内固定器材如何选择及临床疗效。
方法：2002年3月至2005年2月南昌大学第二附属医院分别采用动力髋螺钉DHS(A组)、股骨近端髓内钉PFN(B组)内固定治疗两组共81例股骨粗隆间骨折患者。通过从手术时间、切口长度，X线暴露次数、术中出血量、术后引流量、骨折临床愈合时间、术后并发症、术后功能恢复程度等方面比较两组间的结果，分析两种内固定方式的疗效，以及如何根据骨折类型选择适合内固定器材。
结果：A组和B组在切口长度、术中X线暴露次数、术中出血量、骨折临床愈合时间、术后功能恢复程度等方面有统计学意义(P＜0.05)。与A组相比较B组切口长度小，术中出血量少，骨折临床愈合时间短，术后功能恢复好，但X线暴露次数增加。
结论：对AO分类的A1和A2.1型稳定粗隆间骨折适用于DHS，对于A1、A2.2，A2.3，A3型应选用PFN治疗。
Objective: To compare and to assess the treatment of intertrochanteric fractures by proximal femoral nail (PFN) and dynamic hip screw (DHS). Methods: From March 2002 to February 2005, 98 cases with intertrochanteric hip fractures were followed up. They were treated with dynamic hip screw (DHS group A) and proximal femoral nail (PFN group B). The data of two groups were collected for statistical analysis on the following aspects: operative time, length of incision, fluoroscopy time, blood loss, drainage, time of fracture clinical healing, postoperative complications, Sanders Hip score.
Results: The differences of the length of incision, fluoroscopy time, blood loss and time of fracture clinical healing between group A and group B were of statistical significance (P<0.05). In comparing with group A group B was of shorter clinical healing, fewer blood loss and shorter length of incision, but of more fluoroscopy exposures. The differences in postoperative complications between two groups were no statistical significance (P>0.05).
Conclusion: By comparison, for A1 and A2.1 DHS is applicable. For A1、A2.2, A2.3, A3 PFN is applicable.
方法：2002年3月至2005年2月南昌大学第二附属医院分别采用动力髋螺钉DHS(A组)、股骨近端髓内钉PFN(B组)内固定治疗两组共81例股骨粗隆间骨折患者。通过从手术时间、切口长度，X线暴露次数、术中出血量、术后引流量、骨折临床愈合时间、术后并发症、术后功能恢复程度等方面比较两组间的结果，分析两种内固定方式的疗效，以及如何根据骨折类型选择适合内固定器材。
结果：A组和B组在切口长度、术中X线暴露次数、术中出血量、骨折临床愈合时间、术后功能恢复程度等方面有统计学意义(P＜0.05)。与A组相比较B组切口长度小，术中出血量少，骨折临床愈合时间短，术后功能恢复好，但X线暴露次数增加。
结论：对AO分类的A1和A2.1型稳定粗隆间骨折适用于DHS，对于A1、A2.2，A2.3，A3型应选用PFN治疗。
Objective: To compare and to assess the treatment of intertrochanteric fractures by proximal femoral nail (PFN) and dynamic hip screw (DHS). Methods: From March 2002 to February 2005, 98 cases with intertrochanteric hip fractures were followed up. They were treated with dynamic hip screw (DHS group A) and proximal femoral nail (PFN group B). The data of two groups were collected for statistical analysis on the following aspects: operative time, length of incision, fluoroscopy time, blood loss, drainage, time of fracture clinical healing, postoperative complications, Sanders Hip score.
Results: The differences of the length of incision, fluoroscopy time, blood loss and time of fracture clinical healing between group A and group B were of statistical significance (P<0.05). In comparing with group A group B was of shorter clinical healing, fewer blood loss and shorter length of incision, but of more fluoroscopy exposures. The differences in postoperative complications between two groups were no statistical significance (P>0.05).
Conclusion: By comparison, for A1 and A2.1 DHS is applicable. For A1、A2.2, A2.3, A3 PFN is applicable.
引文
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12. Bartonicek I, Dousa P. Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate of intertrochanteric fractures of the femur. J Orthop Trauma 2002; 16:363-4.
13. Huber SM, Heining SM, Euler E. Pertrochanteric fracture fixation: photoelastic stress measurement comparing dynamic hip screw, y-nail and proximal femur nail. J Bone Joint Surg[Br] 1997; 79-B(Suppl Ⅱ): 166.
14. Ellis TJ, Kyle RF, The results of open reduction internal fixation of a highly unstable interrochanteric hip fracture with a dynamic hip screw. Presented as aposter exhibit at the Annual Meeting of the American A cademu of Orthopaedic Surgeons; 2000, 15-19; Orlando, FL.
15. Gurtler RA. Biomechanical evaluation of the Ender pins, the Harris nail, and the dynamic hip screw for the unstable intertrochanteric fractures. Clin Orthop, 1986, 172: 329.
16. Domingo LJ, Cecilia D, Herrera A, Resines C. Trochanteric fractures treated with a proximal femoral nail. Int Orthop 2001; 25: 298-301.
17．王建辉，刘长贵，刘瑞波．PFN和DHS治疗股骨转子间骨折的生物力学研究及临床分析．骨与关节损伤杂志，2004，11：793-741．
18. Osnes EK, Lofthus CM, Falch JA, et al. More postoperative femoral fractures with the Gamma nail than the sliding screw plate in the treatment of trochanteric fractures. Acta Orthop Scand 2001; 72:252-6.
19. Ahrengart L, Tornkvist H, Fornander P, et al. A randomized study of the compression hip screw and Gamma nail in 426 fracture. Clin Orthop, 2002, 401:209-222.
20. Boldin C, seibert FJ, Frankhauser F, et al. The proximal femoral nail(PFN)-a minimal invasive treatment of unstable proximal fractures: a prospective study of 55 patients with a follow up 15 months. Acta Orthop Scand, 2003, 74: 53-58.
21. Banan H, Al-Sabti A, Jimulia T, et al. The treatment of unstable, extracapsular hip fractures with the AO/ASIF proximal femoral nail(PFN): our first 60 cases. injury, 2002, 33:401-405.
22. Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail: A RANDOMISED STUDY COMPARING POST-OPERATIVE REHABILITATION.
23．张经纬，蒋垚，张先龙，冯建翔．股骨转子间骨折不同手术方法比较，中华骨科杂志．2005，1：7-11．
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29. Simpson AHRW, Varty K, Ddodd CAF. Sliding hip screws: modes of failure. Injure, 1989, 20:227.
30. Saudan M, Lubbeke A, Sadowski C, et al. Pertrochanteric fractures: is there an advantage to an intramedullary nail?: a randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail. J Orthop Trauma 2002; 16:386-93.
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33. Al-yassari G, Langstaff RJ, Jones JW, Al Lami M. The AO/ASIF proximal femoral nail (PFN) for the treatment of unstable trochanteric femoral fracture. Injury 2002; 33:395-9.
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2. Jensen JS, Tondevold E, Sonne-Holm S. Stable trochanteric fractures, A comparative analysis of four methods of internal fixation. Axta Orthop Scand, 1980,51:811-816.
3. MadsenJE, NaessL, AuneAK et al. Dynamic hip screw with trochanter stabilizing plate in the treatment of unstable proximal femoral fractures: a comparative study with the gamma nail and compressionhip screw[J].J Orthop Trauma, 1998; 12(4):241-248.
4. Dujardin FH, Benez C, Polle G, Alain J, Biga N, Thomine JM. Prospective randomized comparison between a dynamic hip screw and a mini-invasive static nail in fractures of the trochanteric area pleliminarv results. J Orthop Truma. 2001,15: 401 -406.
5. Sanders R, Regazzoni P, Proutt M L Jr, The treatment og subtrochanteric fractures of the femur using the dynamic condylar crew, Presentdf at American Academy of Orthopaedic Surgeons Annual Meeting, Atlanta, 1988,4-9.
6. 顾立强. 股骨近端骨折的分类与功能评分. 中华创伤骨科杂志, 2004, 5: 558-563.
7. Brodle SH, Patel AD, Bireher M. Fixation of intertrochanteric fractures of the femur. A randomized prospective comparison of the gamma nail and the dynamic hip screw. J bone Joint Surg (Br), 1991,73:330-334.
8. Lustenberger A, Aanz R, Epidemiologie trochanterer femurfrakturen ber 2 Jahrzehnte(1972-1989). Unfallchirurg, 1995,98:278.
9. Simmpson AHRW, Varty K, Ddodd CAF, Sliding hop screws: modes of failure. Injury, 1989,20:227.
10. Wu CC, Shih WLT, Lee MY, Tai CL. Biomechanical analysis of location of lag screw of a dynamic hip screw in treatment of unstable intertrochanteric fracture. J Trauma 1996; 41:699-702.
11. Bannister GC, Gibson AG, Ackroyd CE, Newman JH. The fixation and prognosis of trochanteric fractures: a randomized prospective controlled trial. Clin Orthop 1990; 254:242-6.
12. Bartonicek I, Dousa P. Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate of intertrochanteric fractures of the femur. J Orthop Trauma 2002; 16:363-4.
13. Huber SM, Heining SM, Euler E. Pertrochanteric fracture fixation: photoelastic stress measurement comparing dynamic hip screw, y-nail and proximal femur nail. J Bone Joint Surg[Br] 1997; 79-B(Suppl Ⅱ): 166.
14. Ellis TJ, Kyle RF, The results of open reduction internal fixation of a highly unstable interrochanteric hip fracture with a dynamic hip screw. Presented as aposter exhibit at the Annual Meeting of the American A cademu of Orthopaedic Surgeons; 2000, 15-19; Orlando, FL.
15. Gurtler RA. Biomechanical evaluation of the Ender pins, the Harris nail, and the dynamic hip screw for the unstable intertrochanteric fractures. Clin Orthop, 1986, 172: 329.
16. Domingo LJ, Cecilia D, Herrera A, Resines C. Trochanteric fractures treated with a proximal femoral nail. Int Orthop 2001; 25: 298-301.
17．王建辉，刘长贵，刘瑞波．PFN和DHS治疗股骨转子间骨折的生物力学研究及临床分析．骨与关节损伤杂志，2004，11：793-741．
18. Osnes EK, Lofthus CM, Falch JA, et al. More postoperative femoral fractures with the Gamma nail than the sliding screw plate in the treatment of trochanteric fractures. Acta Orthop Scand 2001; 72:252-6.
19. Ahrengart L, Tornkvist H, Fornander P, et al. A randomized study of the compression hip screw and Gamma nail in 426 fracture. Clin Orthop, 2002, 401:209-222.
20. Boldin C, seibert FJ, Frankhauser F, et al. The proximal femoral nail(PFN)-a minimal invasive treatment of unstable proximal fractures: a prospective study of 55 patients with a follow up 15 months. Acta Orthop Scand, 2003, 74: 53-58.
21. Banan H, Al-Sabti A, Jimulia T, et al. The treatment of unstable, extracapsular hip fractures with the AO/ASIF proximal femoral nail(PFN): our first 60 cases. injury, 2002, 33:401-405.
22. Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail: A RANDOMISED STUDY COMPARING POST-OPERATIVE REHABILITATION.
23．张经纬，蒋垚，张先龙，冯建翔．股骨转子间骨折不同手术方法比较，中华骨科杂志．2005，1：7-11．
24. Baumgaertner MR, Curtin SL, Lindskog DM. The value of the tip-apex distance in predicting failure of fixation of peritroochanteric fractures of the hip. J Bone Joint Surg(Br) 1995, 77:1058-1064.
25．王满宜．加强股骨近端骨折的临床研究．中华创伤骨科杂志．2004，5：481-483．
26．危杰．股骨转子间骨折．中华创伤骨科杂志，2004，5：554-557．
27. Simmermacher RK. Bosch AM. Van der Werken C. AO/ASIF-proximal femoral nail(PFN): a new device for treatment of unstable proximal femoral fractures. Injury, 1999, 30: 327-332.
28. Huber SM, Heining SM, Euler E. Pertrochanteric fracture fixation: photoelastic stress measurement comparing dynamic hip screw, y-nail and proximal femur nail. J Bone Joint Surg[Br] 1997; 79-B(Suppl Ⅱ):166.
29. Simpson AHRW, Varty K, Ddodd CAF. Sliding hip screws: modes of failure. Injure, 1989, 20:227.
30. Saudan M, Lubbeke A, Sadowski C, et al. Pertrochanteric fractures: is there an advantage to an intramedullary nail?: a randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail. J Orthop Trauma 2002; 16:386-93.
31．荣国威，王承武．骨折，人民卫生出版社出版 第一版．
32. Schipper IB, Bresina S, Wahl D, et al. Biomechanical evaluation of the proximal femoral nail. Clin Orthop 2002; 405:277-86.
33. Al-yassari G, Langstaff RJ, Jones JW, Al Lami M. The AO/ASIF proximal femoral nail (PFN) for the treatment of unstable trochanteric femoral fracture. Injury 2002; 33:395-9.
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