PFNA与DHS治疗EvansⅠ型老年股骨粗隆间骨折的疗效分析
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摘要
目的 比较EvansⅠ型老年股骨粗隆间骨折的应用动力髋螺钉(DHS)和股骨近端防旋髓内钉(PFNA)治疗的临床疗效。方法 选取2009年2月至2013年4月收治的62例EvansⅠ型老年股骨粗隆间骨折患者,其中DHS组30例采用动力髋螺钉进行内固定治疗,PFNA组32例采用股骨近端防旋髓内钉内固定手术治疗,比较2组患者VAS评分、手术时间、术中出血量、住院时间、骨折愈合时间、术后并发症及患髋功能恢复情况。结果 患者均获随访,随访时间12～32个月,平均(15.0±3.2)个月,DHS组有内固定失败2例,1例患者术后出现伤口液化,经过换药处理后痊愈,PFNA组有内固定失败1例,骨不愈合或延迟愈合1例。PFNA组较DHS组在手术时间、术中出血量、住院时间比较,差异有统计学意义(P<0.05),术后髋关节功能Harris评分方面有优势。2组术后VAS评分、骨折愈合时间比较差异无统计学意义(P>0.05)。结论 PFNA和DHS内固定手术都是治疗EvansⅠ股骨粗隆间骨折的有效治疗方法,PFNA手术创伤较小、术中出血量少,而且并发症少,住院时间较短,髋关节功能恢复更好。
Objective To compare the therapeutic effects of proximal femoral nail antirotation(PFNA) and dynamic hip screw(DHS) in the treatment of Evans type Ⅰ intertrochanteric fracture in elderly patients.Methods Sixty-two elderly patients with Evans type Ⅰ intertrochanteric fracture, who were admitted and treated in our hospital from February 2009 to April 2013, were divided into PFNA group(n=32) and DHS group(n=30). The patients in DHS group were treated by dynamic hip screw,however, the patients in PFNA group were treated by proximal femoral nail antirotation. The VAS scores, operation time, intraoperative blood loss, hospital stay, healing time, complications and recovery of hip function of the patients were observed and compared between the two groups. In addition, all patients were followed up for 12 to 32 months( a median of 15.0±3.2 months).Results There were 2 cases of internal fixation failure, 1 case of wound liquefaction after operation, which was cured after dressing change in DHS group. And there was 1 case of internal fixation failure and 1 case of bone nonunion or delayed healing in PFNA group. Moreover, there were significant difference in operation time, intraoperative blood loss and hospital stay between the two groups(P<0.05) whereas there were significant no difference in VAS scores and healing time between the two groups(P>0.05). In addition, the Harris scores of hip function of the patients in in PFNA group were higher than those in DHS group.Conclusion Both PFNA and DHS are effective in treating Evans Ⅰ intertrochanteric fracture in elderly patients. But PFNA is better, which is characterized by less trauma, less bleeding, fewer complications, shorter hospital stay and better recovery of hip function.
Objective To compare the therapeutic effects of proximal femoral nail antirotation(PFNA) and dynamic hip screw(DHS) in the treatment of Evans type Ⅰ intertrochanteric fracture in elderly patients.Methods Sixty-two elderly patients with Evans type Ⅰ intertrochanteric fracture, who were admitted and treated in our hospital from February 2009 to April 2013, were divided into PFNA group(n=32) and DHS group(n=30). The patients in DHS group were treated by dynamic hip screw,however, the patients in PFNA group were treated by proximal femoral nail antirotation. The VAS scores, operation time, intraoperative blood loss, hospital stay, healing time, complications and recovery of hip function of the patients were observed and compared between the two groups. In addition, all patients were followed up for 12 to 32 months( a median of 15.0±3.2 months).Results There were 2 cases of internal fixation failure, 1 case of wound liquefaction after operation, which was cured after dressing change in DHS group. And there was 1 case of internal fixation failure and 1 case of bone nonunion or delayed healing in PFNA group. Moreover, there were significant difference in operation time, intraoperative blood loss and hospital stay between the two groups(P<0.05) whereas there were significant no difference in VAS scores and healing time between the two groups(P>0.05). In addition, the Harris scores of hip function of the patients in in PFNA group were higher than those in DHS group.Conclusion Both PFNA and DHS are effective in treating Evans Ⅰ intertrochanteric fracture in elderly patients. But PFNA is better, which is characterized by less trauma, less bleeding, fewer complications, shorter hospital stay and better recovery of hip function.
引文
1 李意,李新志.股骨粗隆间骨折内固定手术治疗的研究进展.重庆医学,2013,42:1172-1175.
2 郭永智,桑庆华,于晨,等.PFNA与DHS内固定治疗骨质疏松性股骨粗隆间骨折的Meta分析.中国骨与关节损伤杂志,2014,6:537-540.
3 Imren Y,Gurkan V,Bilsel K,et al.Biomechanical comparison of dynamic hip screw,proximal femoral nail,cannulated screw,and monoaxial external fixation in the treatment of basicervical femoral neck fractures.Acta Chir Orthop Traumatol Cech,2015,82:140-144.
4 徐诗雄,洪顺红,孙文栋.老年股骨粗隆间骨折术后髋关节功能恢复的影响因素.中国老年学杂志,2014,7:3353-3355.
5 郑艳峰,吴勋,周荣昌,等.股骨近端防旋髓内钉内固定与动力髋螺钉内固定治疗老年股骨转子间骨折的对比研究.中医正骨,2015,4:24-28.
6 蒋忠,沙蕉,王磊,等.老年股骨粗隆间骨折围手术期治疗策略.中国骨与关节损伤杂志,2013,28:144-155.
7 叶秀章,顾龙殿,周成欢,等.DHS与PFNA内固定治疗股骨粗隆间骨折的疗效分析.中国骨与关节损伤杂志,2013,4:346-347.
8 林晓毅,袁华,游戊已.DHS,LPFP,PFN和PFNA治疗老年股骨粗隆间骨折临床分析.中国骨与关节损伤杂志,2011,26:878.
9 张长青,张春啸,张文治,等.PFNA与PFN内固定治疗老年股骨粗隆间骨折的临床疗效评价.生物骨材料与临床研究,2014,11:51.
10 吴立君,刘岩,唐子华,等.Gamma 3钉与PFNA治疗老年不稳定股骨粗隆间骨折的疗效比较.中国骨与关节损伤杂志,2011,26:723.
11 李大鹏,黄永辉,沈铁城,等.DHS与PFNA治疗骨质疏松性股骨粗隆间骨折疗效分析.临床医学工程,2012,19:364.
12 顾春生,崇汉卿.股骨粗隆间骨折不同内固定术式的疗效分析.中国骨与关节损伤杂志,2011,26:1107-1108.
13 倪诚,戴克戎.股骨距对股骨上段应力分布的影响及其临床意义.中华外科杂志,1989,27:333.
14 郑煜晖,傅捷辉,傅小杯,等.PFNA治疗老年股骨转子间骨折.中国骨与关节损伤杂志,2008,23:151.
15 范忠明,曹阳,伍瓒,等.PFNA治疗老年股骨转子间骨折.中国骨与关节损伤杂志,2009,24:151-153.
2 郭永智,桑庆华,于晨,等.PFNA与DHS内固定治疗骨质疏松性股骨粗隆间骨折的Meta分析.中国骨与关节损伤杂志,2014,6:537-540.
3 Imren Y,Gurkan V,Bilsel K,et al.Biomechanical comparison of dynamic hip screw,proximal femoral nail,cannulated screw,and monoaxial external fixation in the treatment of basicervical femoral neck fractures.Acta Chir Orthop Traumatol Cech,2015,82:140-144.
4 徐诗雄,洪顺红,孙文栋.老年股骨粗隆间骨折术后髋关节功能恢复的影响因素.中国老年学杂志,2014,7:3353-3355.
5 郑艳峰,吴勋,周荣昌,等.股骨近端防旋髓内钉内固定与动力髋螺钉内固定治疗老年股骨转子间骨折的对比研究.中医正骨,2015,4:24-28.
6 蒋忠,沙蕉,王磊,等.老年股骨粗隆间骨折围手术期治疗策略.中国骨与关节损伤杂志,2013,28:144-155.
7 叶秀章,顾龙殿,周成欢,等.DHS与PFNA内固定治疗股骨粗隆间骨折的疗效分析.中国骨与关节损伤杂志,2013,4:346-347.
8 林晓毅,袁华,游戊已.DHS,LPFP,PFN和PFNA治疗老年股骨粗隆间骨折临床分析.中国骨与关节损伤杂志,2011,26:878.
9 张长青,张春啸,张文治,等.PFNA与PFN内固定治疗老年股骨粗隆间骨折的临床疗效评价.生物骨材料与临床研究,2014,11:51.
10 吴立君,刘岩,唐子华,等.Gamma 3钉与PFNA治疗老年不稳定股骨粗隆间骨折的疗效比较.中国骨与关节损伤杂志,2011,26:723.
11 李大鹏,黄永辉,沈铁城,等.DHS与PFNA治疗骨质疏松性股骨粗隆间骨折疗效分析.临床医学工程,2012,19:364.
12 顾春生,崇汉卿.股骨粗隆间骨折不同内固定术式的疗效分析.中国骨与关节损伤杂志,2011,26:1107-1108.
13 倪诚,戴克戎.股骨距对股骨上段应力分布的影响及其临床意义.中华外科杂志,1989,27:333.
14 郑煜晖,傅捷辉,傅小杯,等.PFNA治疗老年股骨转子间骨折.中国骨与关节损伤杂志,2008,23:151.
15 范忠明,曹阳,伍瓒,等.PFNA治疗老年股骨转子间骨折.中国骨与关节损伤杂志,2009,24:151-153.