CAJ | 학술논문

目的：分析应用动力髋螺钉(dynamic hip screw ,DHS)与股骨近端解剖锁定钢板(anatomic proximal femoral locking plate, ALP)和防旋型股骨近端髓内钉（proximal femoral nail anti-rotation,PFNA）对股骨粗隆间骨折进行治疗的治疗效效。对老年股骨粗隆间骨折合理的内固定治疗方法进行探讨。方法对2005年3月~2013年10月采用动力髋螺钉(DHS组46例)、股骨近端解剖锁定钢板(ALP组37例)和防旋型股骨近端髓内钉(PFNA组43例)治疗并对126位老年股骨粗隆间骨折病人进行随访。比较3组患者手术情况、术中和术后并发症、疗效及骨折愈合时间。结果各组间平均手术时间和术中出血量两两比较都有统计学差异(P<0.01)。三组术中、术后并发症发生率有统计学差异(P<0.05), PFNA组术中、术后并发症发生率比DHS组和ALP组低。 DHS组、ALP组和PFNA组优良率分别为84.78%、86.49%和90.70%,组间疗效差异无统计学意义(P>0.05)。 PFNA组与DHS组骨折愈合时间有统计学差异(P<0.01),而ALP组与PFNA组间无统计学差异(P>0.05)。结论应用DHS、ALP和PFNA治疗老年股骨粗隆间骨折,在疗效方面无明显差异。PFNA内固定平均手术时间最短,术中出血量最少,术中、术后并发症发生几率低,骨折愈合时间短。PFNA对骨折端的血循环影响和骨质破坏较小,固定更为牢靠,是治疗老年股骨粗隆间骨折的合理手术方法。对于身体状况较差、不能耐受较长时间手术者，可优先考虑此手术方式。
목적：분석응용동력관라정(dynamic hip screw ,DHS)여고골근단해부쇄정강판(anatomic proximal femoral locking plate, ALP)화방선형고골근단수내정（proximal femoral nail anti-rotation,PFNA）대고골조륭간골절진행치료적치료효효。대노년고골조륭간골절합리적내고정치료방법진행탐토。방법대2005년3월~2013년10월채용동력관라정(DHS조46례)、고골근단해부쇄정강판(ALP조37례)화방선형고골근단수내정(PFNA조43례)치료병대126위노년고골조륭간골절병인진행수방。비교3조환자수술정황、술중화술후병발증、료효급골절유합시간。결과각조간평균수술시간화술중출혈량량량비교도유통계학차이(P<0.01)。삼조술중、술후병발증발생솔유통계학차이(P<0.05), PFNA조술중、술후병발증발생솔비DHS조화ALP조저。 DHS조、ALP조화PFNA조우량솔분별위84.78%、86.49%화90.70%,조간료효차이무통계학의의(P>0.05)。 PFNA조여DHS조골절유합시간유통계학차이(P<0.01),이ALP조여PFNA조간무통계학차이(P>0.05)。결론응용DHS、ALP화PFNA치료노년고골조륭간골절,재료효방면무명현차이。PFNA내고정평균수술시간최단,술중출혈량최소,술중、술후병발증발생궤솔저,골절유합시간단。PFNA대골절단적혈순배영향화골질파배교소,고정경위뢰고,시치료노년고골조륭간골절적합리수술방법。대우신체상황교차、불능내수교장시간수술자，가우선고필차수술방식。
Objective:To analyze the curative effects of dynamic hip screw (DHS)、anatomic proximal femoral locking plate (ALP) and proximal femoral nail anti-rotation(PFNA), which are applied to patients with intertrochanteric fracture;to discuss the suitable internal fixation treatment of elderly femoral intertrochanteric fractures.Methods:126 elderly patients with femoral intertrochanteric fractures were engaged, which were treated by dynamic hip screw (DHS group of 46 cases), anatomic proximal femoral locking plate (ALP group 37 cas-es)and the screw type proximal femoral nailing anti-rotation (PNFA group of 43 cases) from March,2005 to October,2013. Compare the surgery situations, intraoperative and postoperative complications, efficacy and fracture healing time of 3 groups in treatment and follow-up studies. Result:The comparisons of each two groups in average operative time and intraoperative blood loss are statistically significant (P<0.01).In the 3 groups, the incidence of postoperative complications is statistically significant (P<0. 05).The incidence of intraoperative and postoperative complications in PNFA group is lower than that in DHS group and ALP g roup. The results of DHS group、ALP group and PFNA group were rated as good or excellent respectively in 84.78%、86.49%and 90.70%,The difference of curative effect between the groups has no statistical significance( P>0.05).The fracture healing time of PFNA group and DHS group isstatistically significant (P<0.01), while the ALP group and PFNA group have no statistical significance (P>0.05).Conclusion:The curative effects of dynamic hip screw (DHS)、anatomic proximal femoral locking plate(ALP) and proximal femoral nail anti-rotation(PFNA), which are applied to patients with intertrochanteric fracture have no obvious difference. PFNA internal fixation has the shortest operation time, the least intraoperative blood loss, at the same time, the incidence of intraoperative and postoperative complications in PNFA group is low, thefracture healing time is quite shot. PFNA has low impact on the blood circulation of the fracture ends and small bone destruction, the fixation could be more firm. As a result, PNFA is the reasonable operation method to treat the elderly femoral intertrochanteric fractures. For the patients who have a bad physical condition and could not tolerate long operation time, PFNA can be the preference selection.