Kumar Ranjeetesh, Singh R N, Singh B N
Anup Memorial Orthopedic Centre, 375, 77 PC Colony, Kankar Bagh, Patna 800020, India.
J Clin Orthop Trauma. 2012 Jun;3(1):28-36. doi: 10.1016/j.jcot.2011.12.001. Epub 2012 Jun 16.
The aim of this study was to compare the outcome of intertrochanteric fractures treated with Dynamic Hip Screw and Proximal Femoral nail.
This study was conducted on 50 cases of Intertrochanteric fractures of femur treated by a dynamic hip screw and proximal femoral nail. Patients were operated on standard fracture table under image intensifier control.
The average age of the patient was 62.3 years. Most common mechanism of fracture was domestic fall. Twenty percent four percent had stable, 58% unstable and 18% reverse oblique pattern of fracture. The unstable pattern was more common in old aged patients with higher grade of osteoporosis. The average blood loss was 100 and 250 ml in PFN and DHS group respectively. In PFN there were more no. of radiation exposure intraoperatively. The average operating time for the patients treated with PFN was 55 min as compared to 87 min in patients treated with DHS. Total complications were 15% with implant failure 6%, infection 4%, nonunion 2% and greater trochanter splintering 4%. In the PFN group the amount of sliding on X-rays was less as compared to DHS. The patients treated with PFN started early ambulation as they had better Harris Hip Score in the early period (at 1 and 3 month). In the long term both the implant had almost similar functional outcomes.
The DHS was tolerated better by young patients with stable fracture while PFN had a better outcome with osteoporotic patients and weak bone mass and reverse oblique fractures.
本研究旨在比较动力髋螺钉和股骨近端髓内钉治疗股骨粗隆间骨折的疗效。
本研究对50例采用动力髋螺钉和股骨近端髓内钉治疗的股骨粗隆间骨折患者进行。患者在影像增强器控制下于标准骨折手术台上接受手术。
患者的平均年龄为62.3岁。最常见的骨折机制是在家中跌倒。24%的骨折为稳定型，58%为不稳定型，18%为反斜型骨折。不稳定型骨折在老年骨质疏松程度较高的患者中更为常见。PFN组和DHS组的平均失血量分别为100毫升和250毫升。PFN组术中的放射暴露次数更多。PFN治疗患者的平均手术时间为55分钟，而DHS治疗患者的平均手术时间为87分钟。总并发症发生率为15%，其中内固定失败6%，感染4%，骨不连2%，大转子劈裂4%。与DHS相比，PFN组X线片上的滑动量较少。PFN治疗的患者早期活动更早，因为他们在早期（1个月和3个月时）的Harris髋关节评分更高。从长期来看，两种内固定的功能结局几乎相似。
对于骨折稳定的年轻患者，DHS的耐受性更好，而PFN对于骨质疏松患者、骨质薄弱和反斜型骨折患者的疗效更好。
