[1]徐雍剑.抗旋转型股骨近端髓内钉与动力髋螺钉治疗股骨转子间骨折的比较研究[J].中医正骨,2013,25(06):20-23.
　XU Yong-jian.Comparison of proximal femoral nail antirotation and dynamic hip screw for the treatment of intertrochanteric fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2013,25(06):20-23.
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抗旋转型股骨近端髓内钉与动力髋螺钉治疗股骨转子间 骨折的比较研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第25卷
期数:
2013年06期
页码:
20-23
栏目:
临床研究
出版日期:
2013-06-30

文章信息/Info

Title:
Comparison of proximal femoral nail antirotation and dynamic hip screw for the treatment of intertrochanteric fractures
作者:
徐雍剑
浙江省常山县人民医院,浙江 常山 324200
Author(s):
XU Yong-jian
People's Hospital of Changshan,Changshan 324200,Zhejiang,China
关键词:
髋骨折 转子间骨折 骨折固定术; 内 抗旋转型股骨近端髓内钉 动力髋螺钉
Keywords:
Hip fractures;  Intertrochanteric fractures;  Fracture fixation; internal;  Proximal femoral nail antirotation;  Dynamic hip screw
摘要:
目的:比较抗旋转型股骨近端髓内钉内固定与动力髋螺钉内固定治疗股骨转子间骨折的临床疗效及安全性。方法:将纳入研究的51例股骨转子间骨折患者随机分为2组,26例采用抗旋转型股骨近端髓内钉内固定,25例采用动力髋螺钉内固定。其中Evans-JensenⅠa型5例,Ⅰb型10例,Ⅱa型11例,Ⅱb型12例,Ⅲ型13例。观察并比较2组患者手术时间、术中出血量、术后开始下地负重行走时间、骨折愈合时间及术后并发症发生情况,并对2组患者治疗前后Harris髋关节功能评分进行比较。结果:①一般情况。2组患者手术时间比较,差异无统计学意义[(45±8)min,(46±9)min,t=12.653,P=0.150]; 抗旋转型股骨近端髓内钉组患者术中出血量少于动力髋螺钉组[(310±110)mL,(400±140)mL,t=9.234,P=0.020],术后开始下地负重行走时间早于动力髋螺钉组[(12±7)d,(25±8)d,t=8.702,P=0.020]。②临床疗效。抗旋转型股骨近端髓内钉组患者的骨折愈合时间比动力髋螺钉组短[(13.2±2.7)周,(17.2±3.3)周,t=3.478,P=0.020]。2组患者术后的Harris髋关节功能评分均较治疗前增加; 抗旋转型股骨近端髓内钉组患者的髋关节功能、运动范围及综合评分的增加值均高于动力髋螺钉组[(30.2±3.3)分,(16.7±3.0)分,t=2.570,P=0.004;(2.4±0.6)分,(1.1±0.5)分,t=2.620,P=0.006;(62.1±3.8)分,(46.1±3.7)分,t=3.322,P=0.000],而髋关节畸形评分的增加值低于动力髋螺钉组[(1.3±0.4)分,(4.5±0.7)分,t=2.837,P=0.003]; 2组患者髋关节疼痛评分的增加值比较,差异无统计学意义[(26.7±2.7)分,(26.9±2.9)分,t=0.988,P=0.150]。③安全性。术后抗旋转型股骨近端髓内钉组1例患者出现髋关节畸形,1例患者出现内固定松动; 动力髋螺钉组术后1例患者出现感染,5例患者出现髋关节畸形,5例患者术后出现内固定松动。抗旋转型股骨近端髓内钉组患者术后并发症发生率低于动力髋螺钉组(χ2=8.846,P=0.003)。结论:对于Evans-JensenⅠ、Ⅱ、Ⅲ型股骨转子间骨折患者而言,与动力髋螺钉内固定相比,抗旋转型股骨近端髓内钉内固定术中出血量少、骨折愈合时间早、术后可早期进行功能锻炼及下地负重行走、术后并发症少、髋关节功能恢复好,是治疗股骨转子间骨折的理想手术方式。
Abstract:
Objective:To compare the general conditions,clinical curative effects and safety between the therapy of proximal femoral nail antirotation(PFNA)fixation and the therapy of dynamic hip screw(DHS)fixation for the treatment of intertrochanteric fractures.Methods:Fifty-one patients with intertrochanteric fractures were included into the study and were divided into 2 groups.Twenty-six patients were administrated with PFNA fixation(PFNA group),while the others were administrated with DHS fixation(DHS group).The fractures belonged to Evans-Jensen typesⅠa(5),Ⅰb(10),Ⅱa(11),Ⅱb(12)andⅢ(13).The 2 groups were compared with each other in such parameters as operative time,blood loss,bed rest time,fracture healing time,Harris scores and the incidence rate of complications.Results:The blood loss,bed rest time and fracture healing time of PFNA group were all lower than those of DHS group respectively((310±110)mL vs(400±140)mL,t=9.234,P=0.020;(12±7)d vs(25±8)d,t=8.702,P=0.020;(13.2±2.7)weeks vs(17.2±3.3)weeks,t=3.478,P=0.020),while there were no statistical differences in operative time betwee the 2 groups((45±8)min vs(46±9)min,t=12.653,P=0.150).After the treatment,the scores of pain,function,deformity,range of motion(ROM)and Harris total scores all increased in the 2 groups.The increased value of function scores,ROM scores and Harris total scores of PFNA group were all greater than those of DHS group((30.2±3.3)vs(16.7±3.0),t=2.570,P=0.004;(2.4±0.6)vs(1.1±0.5),t=2.620,P=0.006;(62.1±3.8)vs(46.1±3.7),t=3.322,P=0.000),and the increased value of deformity scores of PFNA group was less than that of DHS group((1.3±0.4)vs(4.5±0.7),t=2.837,P=0.003),while there was no statistical difference in increased value of pain scores between the 2 groups((26.7±2.7)vs(26.9±2.9),t=0.988,P=0.150).One patient with hip joint deformitiy and 1 patient with loosening internal fixation were found in PFNA group,while 1 patient with infection,5 patients with hip joint deformitiy and 5 patients with loosening internal fixation were found in DHS group.The incidence rate of complications was lower in PFNA group compared with that in DHS group(χ2=8.846,P=0.003).Conclusion:Compared with DHS fixation,the therapy of PFNA fixation has such advantages as less blood loss,shorter fracture healing time,shorter bed rest time,less complications and better function of hip joint for the treatment of Evans-Jensen typeⅠ,Ⅱ,and Ⅲ intertrochanteric fractures.

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更新日期/Last Update: 1900-01-01