Wang W, Zhai S, Han X P, Cui Y
Department One of Orthopedics, the Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China.
Zhonghua Yi Xue Za Zhi. 2018 Jan 30;98(5):357-361. doi: 10.3760/cma.j.issn.0376-2491.2018.05.008.
To compare the effect of proximal femoral nail anti-rotation and dynamic hip screw in treating the femoral intertrochanteric fractures in elderly patients. From June 2011 to June 2014, totally 158 elderly patients of femoral intertrochanteric fracture were treated by surgery, among whom 68 cases were treated with dynamic hip screws (DHS), and 90 patients were treated with proximal femoral nail anti-rotation (PFNA). The operative time, hospitalization time, weight-bearing time, fracture-healing time, blood loss and the hip function score after the operation were compared between the two groups by using the test; and the incidence of the postoperative complication was compared between the two groups by using the Chi square test. All the patients were followed-up for 6 to 18 months (12. 6 months on average). There was no statistic differences in the gender, age, the surgical time after injury and the fracture type between the two groups (χ(2)=0.025, =1.461, 1.329, χ(2)=2.070, all >0.05). While, the operative time, blood loss, hospitalization time and the weight-bearing time in the PFNA group were all significantly lower than those in the DHS group[(47±14) vs (114±20) min, (121±26) vs (281±44) ml, (10.2±3.3) vs (13.5±2.8) d, (29±8) vs (53±10) d, =8.376, 6.669, 2.176, 2.664, all <0.05]; and the Harris hip score of 6 months post operation in PFNA group was significantly higher than that in the DHS group (90±17 vs 87±15, =2.337, <0.05). However, no significant difference in fracture healing time was found between the two groups[(11.8±2.3) vs (12.2±2.7) weeks, =1.114, >0.05]. Moreover, the incidence of complications in the DHS group was 16.2% while it was 7.8% in the PFNA group, the latter was obviously lower (χ(2)=4.801, <0.05). DHS is suitable for the patients with good physical condition or for the patients with stable fracture types. While, PFNA has the advantages of firmly fixation, less tissue damage, lower complications and wide indications. So, it is superior in the femoral intertrochanteric fractures.
比较股骨近端防旋髓内钉与动力髋螺钉治疗老年股骨转子间骨折的效果。2011年6月至2014年6月，共158例老年股骨转子间骨折患者接受手术治疗，其中68例采用动力髋螺钉（DHS）治疗，90例采用股骨近端防旋髓内钉（PFNA）治疗。采用t检验比较两组患者的手术时间、住院时间、负重时间、骨折愈合时间、术中出血量及术后髋关节功能评分；采用χ²检验比较两组患者术后并发症发生率。所有患者均随访6至18个月（平均12.6个月）。两组患者在性别、年龄、受伤至手术时间及骨折类型方面差异无统计学意义（χ²=0.025，t=1.461，t=1.329，χ²=2.070，均>0.05）。然而，PFNA组的手术时间、术中出血量、住院时间及负重时间均显著低于DHS组[（47±14）分钟 vs （114±20）分钟，（121±26）毫升 vs （281±44）毫升，（10.2±3.3）天 vs （13.5±2.8）天，（29±8）天 vs （53±10）天，t=8.376，t=6.669，t=2.176，t=2.664，均<0.05]；PFNA组术后6个月的Harris髋关节评分显著高于DHS组（90±17 vs 87±15，t=2.337，<0.05）。但是，两组患者的骨折愈合时间差异无统计学意义[（11.8±2.3）周 vs （12.2±2.7）周，t=1.114，>0.05]。此外，DHS组并发症发生率为16.2%，而PFNA组为7.8%，后者明显较低（χ²=4.801，<0.05）。DHS适用于身体状况良好或骨折类型稳定的患者。而PFNA具有固定牢固、组织损伤小、并发症少、适应证广等优点。因此，在股骨转子间骨折治疗中PFNA更具优势。
