1Department of Orthopedics, Linyi Second People's Hospital, Linyi, China; and 2Department of General Surgery, Affiliated Hospital of Taishan Medical University, Taian, China.
Am J Ther. 2017 Nov/Dec;24(6):e659-e666. doi: 10.1097/MJT.0000000000000346.
In this study, a randomized trial was conducted to compare the clinical effectiveness of proximal femoral locking compression plate (PFLCP), dynamic hip screw (DHS), and proximal femoral nail antirotation (PFNA) for unstable intertrochanteric femoral fracture treatment. Ninety patients diagnosed with unstable intertrochanteric femoral fracture were enrolled in this study at the department of orthopedics at Linyi Second People's Hospital between May 2010 and May 2012. Fractures were classified according to Tronzo-Evans classification, and the patients were randomly divided into 3 groups, PFLCP, DHS, and PFNA, with 30 patients in each group. The length of incision, operative time, intraoperative blood loss, postoperative drainage, postoperative weight-bearing ambulation time, and duration of fracture union were significantly lower in patients who underwent PFNA and PFLCP compared to patients treated with DHS. Furthermore, when the same clinical parameters were used for comparison, the PFNA group showed markedly lower values compared with the PFLCP group. The total incidence of postoperative complications was significantly different among the PFNA, PFLCP, and DHS groups, with the PFNA group exhibiting markedly lower complication rates compared with PFLCP and DHS groups. However, PFLCP and DHS groups did not show significant differences in the incidence of postoperative complications. Notably, the Harris hip score of PFNA group was markedly higher than the DHS group. In conclusion, our results provide convincing evidence that PFNA may be the most effective internal fixation treatment of unstable intertrochanteric femoral fracture.
在这项研究中，我们进行了一项随机试验，比较了股骨近端锁定加压钢板（PFLCP）、动力髋螺钉（DHS）和股骨近端防旋髓内钉（PFNA）治疗不稳定型股骨转子间骨折的临床疗效。2010 年 5 月至 2012 年 5 月，我院骨科收治了 90 例不稳定型股骨转子间骨折患者，按 Tronzo-Evans 分类法进行分类，将患者随机分为三组，即 PFLCP 组、DHS 组和 PFNA 组，每组 30 例。PFNA 和 PFLCP 组的切口长度、手术时间、术中出血量、术后引流量、术后负重行走时间和骨折愈合时间明显低于 DHS 组。此外，当使用相同的临床参数进行比较时，PFNA 组的值明显低于 PFLCP 组。PFNA、PFLCP 和 DHS 组术后并发症总发生率差异有统计学意义，PFNA 组明显低于 PFLCP 和 DHS 组。但 PFLCP 和 DHS 组术后并发症发生率差异无统计学意义。值得注意的是，PFNA 组的 Harris 髋关节评分明显高于 DHS 组。总之，我们的结果提供了令人信服的证据，表明 PFNA 可能是治疗不稳定型股骨转子间骨折最有效的内固定治疗方法。
