中医正骨
中醫正骨
중의정골
THE JOURNAL OF TRADITIONAL CHINESE ORTHOPEDICS AND TRAUMATOLOGY
2015年
4期
24-28
,共5页
郑艳峰%吴勋%周荣昌%陈有芬%朱家骏
鄭豔峰%吳勛%週榮昌%陳有芬%硃傢駿
정염봉%오훈%주영창%진유분%주가준
髋骨折%骨折固定术,内%内固定器%股骨近端防旋髓内钉%动力髋螺钉%老年人%治疗,临床研究性
髖骨摺%骨摺固定術,內%內固定器%股骨近耑防鏇髓內釘%動力髖螺釘%老年人%治療,臨床研究性
관골절%골절고정술,내%내고정기%고골근단방선수내정%동력관라정%노년인%치료,림상연구성
hip fractures%fracture fixation,internal%internal fixators%proximal femoral nail antirotation%dynamic hip screw%aged%thera-pies,investigational
目的：比较股骨近端防旋髓内钉（proximal femoral nail antirotation，PFNA）内固定和动力髋螺钉（dynamic hip screw，DHS）内固定治疗老年股骨转子间骨折的临床疗效和安全性。方法：回顾性分析280例股骨转子间骨折患者的病例资料，其中采用PFNA内固定180例，采用 DHS 内固定100例。男169例，女111例；年龄61～77岁，中位数65岁；按照股骨转子间骨折的 Evans分型，Ⅰ型62例、Ⅱ型73例、Ⅲ型73例、Ⅳ型72例。比较2组患者的切口长度、出血量、手术时间、引流量、卧床时间、骨折愈合时间及并发症发生情况，并于术后6个月比较2组患者的临床疗效。结果：①一般指标。PFNA 组的切口长度、出血量、引流量均小于 DHS 组[（4．44±1．49）cm，（6．34±2．44）cm，t ＝3．737，P ＝0．034；（205．25±24．54）mL，（298．29±28．64）mL，t ＝4．055，P ＝0．028；（64．46±10．67）mL，（105．11±19．84）mL，t ＝4．874，P ＝0．020]，其手术时间、卧床时间、骨折愈合时间均短于 DHS 组[（68．68±14．43）min，（96．44±11．25）min，t ＝4．462，P ＝0．022；（34．51±7．88）d，（53．38±8．59）d，t ＝5．448，P ＝0．016；（3．22±1．13）月，（4．07±1．85）月，t ＝4．366，P ＝0．025]。②临床疗效。PFNA 组优110例、良59例、可10例、差1例，DHS 组优55例、良30例、可10例、差5例；2组患者的临床疗效比较，差异无统计学意义（Z ＝－1．495，P ＝0．135）。③安全性。PFNA 组1例患者术后切口感染，3例患者骨折畸形愈合，4例患者下肢深静脉血栓形成；DHS 组3例患者术后切口感染，2例患者内固定断裂，4例患者骨折畸形愈合，3例患者下肢深静脉血栓形成。PFNA 组并发症发生率低于 DHS 组（χ2＝5．533，P ＝0．019）。结论：对于老年股骨转子间骨折患者而言，虽然 PFNA 内固定与 DHS 内固定在临床疗效方面无明显差异，但 PFNA 内固定具有手术切口小、出血量和引流量少、手术时间短、骨折愈合快、患者卧床时间短、并发症少的优点，是治疗股骨转子间骨折的一种较理想的方法，值得临床推广应用。
目的：比較股骨近耑防鏇髓內釘（proximal femoral nail antirotation，PFNA）內固定和動力髖螺釘（dynamic hip screw，DHS）內固定治療老年股骨轉子間骨摺的臨床療效和安全性。方法：迴顧性分析280例股骨轉子間骨摺患者的病例資料，其中採用PFNA內固定180例，採用 DHS 內固定100例。男169例，女111例；年齡61～77歲，中位數65歲；按照股骨轉子間骨摺的 Evans分型，Ⅰ型62例、Ⅱ型73例、Ⅲ型73例、Ⅳ型72例。比較2組患者的切口長度、齣血量、手術時間、引流量、臥床時間、骨摺愈閤時間及併髮癥髮生情況，併于術後6箇月比較2組患者的臨床療效。結果：①一般指標。PFNA 組的切口長度、齣血量、引流量均小于 DHS 組[（4．44±1．49）cm，（6．34±2．44）cm，t ＝3．737，P ＝0．034；（205．25±24．54）mL，（298．29±28．64）mL，t ＝4．055，P ＝0．028；（64．46±10．67）mL，（105．11±19．84）mL，t ＝4．874，P ＝0．020]，其手術時間、臥床時間、骨摺愈閤時間均短于 DHS 組[（68．68±14．43）min，（96．44±11．25）min，t ＝4．462，P ＝0．022；（34．51±7．88）d，（53．38±8．59）d，t ＝5．448，P ＝0．016；（3．22±1．13）月，（4．07±1．85）月，t ＝4．366，P ＝0．025]。②臨床療效。PFNA 組優110例、良59例、可10例、差1例，DHS 組優55例、良30例、可10例、差5例；2組患者的臨床療效比較，差異無統計學意義（Z ＝－1．495，P ＝0．135）。③安全性。PFNA 組1例患者術後切口感染，3例患者骨摺畸形愈閤，4例患者下肢深靜脈血栓形成；DHS 組3例患者術後切口感染，2例患者內固定斷裂，4例患者骨摺畸形愈閤，3例患者下肢深靜脈血栓形成。PFNA 組併髮癥髮生率低于 DHS 組（χ2＝5．533，P ＝0．019）。結論：對于老年股骨轉子間骨摺患者而言，雖然 PFNA 內固定與 DHS 內固定在臨床療效方麵無明顯差異，但 PFNA 內固定具有手術切口小、齣血量和引流量少、手術時間短、骨摺愈閤快、患者臥床時間短、併髮癥少的優點，是治療股骨轉子間骨摺的一種較理想的方法，值得臨床推廣應用。
목적：비교고골근단방선수내정（proximal femoral nail antirotation，PFNA）내고정화동력관라정（dynamic hip screw，DHS）내고정치료노년고골전자간골절적림상료효화안전성。방법：회고성분석280례고골전자간골절환자적병례자료，기중채용PFNA내고정180례，채용 DHS 내고정100례。남169례，녀111례；년령61～77세，중위수65세；안조고골전자간골절적 Evans분형，Ⅰ형62례、Ⅱ형73례、Ⅲ형73례、Ⅳ형72례。비교2조환자적절구장도、출혈량、수술시간、인류량、와상시간、골절유합시간급병발증발생정황，병우술후6개월비교2조환자적림상료효。결과：①일반지표。PFNA 조적절구장도、출혈량、인류량균소우 DHS 조[（4．44±1．49）cm，（6．34±2．44）cm，t ＝3．737，P ＝0．034；（205．25±24．54）mL，（298．29±28．64）mL，t ＝4．055，P ＝0．028；（64．46±10．67）mL，（105．11±19．84）mL，t ＝4．874，P ＝0．020]，기수술시간、와상시간、골절유합시간균단우 DHS 조[（68．68±14．43）min，（96．44±11．25）min，t ＝4．462，P ＝0．022；（34．51±7．88）d，（53．38±8．59）d，t ＝5．448，P ＝0．016；（3．22±1．13）월，（4．07±1．85）월，t ＝4．366，P ＝0．025]。②림상료효。PFNA 조우110례、량59례、가10례、차1례，DHS 조우55례、량30례、가10례、차5례；2조환자적림상료효비교，차이무통계학의의（Z ＝－1．495，P ＝0．135）。③안전성。PFNA 조1례환자술후절구감염，3례환자골절기형유합，4례환자하지심정맥혈전형성；DHS 조3례환자술후절구감염，2례환자내고정단렬，4례환자골절기형유합，3례환자하지심정맥혈전형성。PFNA 조병발증발생솔저우 DHS 조（χ2＝5．533，P ＝0．019）。결론：대우노년고골전자간골절환자이언，수연 PFNA 내고정여 DHS 내고정재림상료효방면무명현차이，단 PFNA 내고정구유수술절구소、출혈량화인류량소、수술시간단、골절유합쾌、환자와상시간단、병발증소적우점，시치료고골전자간골절적일충교이상적방법，치득림상추엄응용。
Objective:To compare the clinical curative effects and safety of proximal femoral nail antirotation(PFNA)internal fixation versus dynamic hip screw(DHS)internal fixation in the treatment of intertrochanteric fractures in the aged.Methods:The medical records of 280 patients with intertrochanteric fractures were analyzed retrospectively.One hundred and eighty patients were treated with PFNA internal fixation(PFNA group),while the others were treated with DHS internal fixation(DHS group).The patients consisted of 169 males and 111 females,and ranged in age from 61 to 77 years(Median =65 yrs).According to the Evans classification of intertrochanteric fractures,the fractures belonged to typesⅠ(62),Ⅱ(73),Ⅲ(73)and Ⅳ(72).The incision length,blood loss,operative time,volume of drainage,bed rest time,fracture healing time and complications were compared between the 2 groups,and the clinical effects were also compared between the 2 groups at 6 months after surgery.Results:The incision length,blood loss and volume of drainage of PFNA group were less than those of DHS group(4.44 +/-1.49 vs 6.34 +/-2.44 cm,t =3.737,P =0.034;205.25 +/-24.54 vs 298.29 +/-28.64 mL,t =4.055,P =0.028;64.46 +/-10.67 vs 105.11 +/-19.84 mL,t =4.874,P =0.020),and the operative time,bed rest time and fracture healing time were also shorter in PFNA group compared to DHS group(68.68 +/-14.43 vs 96.44 +/-11.25 min,t =4.462,P =0.022;34.51 +/-7.88 vs 53.38 +/-8.59 days,t =5.448,P =0.016;3.22 +/-1.13 vs 4.07 +/-1.85 months,t =4.366,P =0.025).One hundred and ten patients obtained an excellent result,59 good,10 fair and 1 poor in the PFNA group;while 55 patients obtained an excellent result,30 good,10 fair and 5 poor in the DHS group.There was no statistical difference in clinical effects between the 2 groups(Z =-1.495,P =0.135).Incision infection(1 case),fracture malunion(3 cases)and lower extremity deep venous thrombosis(4 cases)were found in PFNA group;while incision infection(3 case),breakage of internal fixation(2 cases),fracture malunion(4 cases)and lower extremity deep venous thrombosis(3 cases)were found in DHS group.The incidence rate of complications of PFNA group was lower than that of DHS group(χ2 =5.533,P =0.019).Conclusion:There are no significant difference in clinical curative effects between PFNA internal fixation and DHS in-ternal fixation,however,PFNA internal fixation is an ideal method for treatment of intertrochanteric fractures in the aged for small incision, less blood loss and volume of drainage,shorter operative time,shorter fracture healing time,shorter bed rest time and less complications,so it is worthy of popularizing in clinic.
