CAJ | 학술논문

目的比较动力髋螺钉(DHS)和防旋股骨近端髓内钉(PFNA)治疗高龄股骨粗隆间骨折的早期疗效.方法回顾性分析89例高龄股骨粗隆间骨折的患者,其中DHS治疗组43例,PFNA治疗组46例.评价2组的切口长度、术中出血量、手术时间、并发症和早期疗效等.结果术后随访9 ～18个月,平均(11.6±2.2)个月.DHS组手术切口长度(9.8±1.3)cm,PFNA组手术切口长度(5.2±0.9)cm,2组比较差异有统计学意义(P＜0.05);DHS组手术时间(85±16) min,PFNA组手术时间(46±11)min,DHS组术中出血量(150±30)ml,PFNA组术中出血量(50±11) ml,2组比较差异有统计学意义(P＜0.01);并发症发生率:PFNA组为4.8％ (2/42),DHS组为15.0％(6/40),2组比较差异有统计学意义(P＜0.05);Harris髋关节功能评分优良率:DHS组为75.0％(30/40),PFNA组为90.5％(38/42),2组比较差异有统计学意义(P＜0.05).结论 PFNA治疗高龄股骨粗隆间骨折具有创伤小、并发症少、固定牢靠、抗旋转、抗切割等优点,但在适应证选择恰当的情况下,DHS及PFNA都是高龄股骨粗隆间骨折患者理想的内固定方式.
목적 비교동력관라정(DHS)화방선고골근단수내정(PFNA)치료고령고골조륭간골절적조기료효.방법 회고성분석89례고령고골조륭간골절적환자,기중DHS치료조43례,PFNA치료조46례.평개2조적절구장도、술중출혈량、수술시간、병발증화조기료효등.결과 술후수방9 ～18개월,평균(11.6±2.2)개월.DHS조수술절구장도(9.8±1.3)cm,PFNA조수술절구장도(5.2±0.9)cm,2조비교차이유통계학의의(P＜0.05);DHS조수술시간(85±16) min,PFNA조수술시간(46±11)min,DHS조술중출혈량(150±30)ml,PFNA조술중출혈량(50±11) ml,2조비교차이유통계학의의(P＜0.01);병발증발생솔:PFNA조위4.8％ (2/42),DHS조위15.0％(6/40),2조비교차이유통계학의의(P＜0.05);Harris관관절공능평분우량솔:DHS조위75.0％(30/40),PFNA조위90.5％(38/42),2조비교차이유통계학의의(P＜0.05).결론 PFNA치료고령고골조륭간골절구유창상소、병발증소、고정뢰고、항선전、항절할등우점,단재괄응증선택흡당적정황하,DHS급PFNA도시고령고골조륭간골절환자이상적내고정방식.
Objective To compare the early efficiency of dynamic hip screw (DHS) and proximal femoral nail antirotation (PFNA) in treatment of elderly femoral intertrochanteric fracture patients.Methods Totally 89 cases of intertrochanteric fracture were retrospectively studied,including 43 patients in both DHS treatment group and DHS group,46 cases in the PFNA group.Incision length,operation time,postoperative complications and early efficacy were analyzed.All patients were followed up for 9 to 18 months with mean (11.6 ± 2.2) months.Results Incision length was (9.8 ± 1.3) cm in DHS group and (5.2 ± 0.9) cm in PFNA group; there was significant difference between two groups (P ＜ 0.05).Operation time was (85 ± 16) min in the DHS group and (46 ± 11) min in the PFNA group; average bleeding volume was (150 ±30) ml in the DHS group and (50 ± 11) ml in the PFNA group,there were significant differences between the two groups (P ＜ 0.01 for both).The overall complication rate was 4.8％ (2/42)in the PFNA group,15.0％ (6/40)in the DHS group; both groups had significant difference (P ＜ 0.05).The excellent and good rate of Harris hip score was 75.0％ (30/40) in DHS group and 90.5 ％ (38/42) in the PFNA group ; both groups were statistically significant (P ＜ 0.05).Conclusions PF-NA treatment for elderly intertrochanteric fracture has advantages of few complications,stable fixation,anti-rotation and anti-cutting.When the indications are proper,DHS and PFNA are ideal fixations treating the elderly patients with the femoral intertrochanteric fractures.