股骨近端髓内钉与动力髋螺钉治疗老年股骨转子间骨折疗效比较
A comparative study of proximal femoral nail and dynamic hip screw treatment of femoral fractures in elderly
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摘要: 目的：探讨股骨近端髓内钉（PFN）与动力髋螺钉（DHS）治疗老年股骨转子间骨折的临床疗效。方法：选取158例老年股骨转子间骨折患者作为研究对象，其中行DHS治疗128例（DHS组），行PFN治疗30例（PFN组）。比较两种手术的治疗效果。结果：DHS组、PFN组A1、A2型骨折患者手术时间、术中出血量、术后引流量和愈合时间差异均无统计学意义（P>0.05）；DHS组A3型骨折患者手术时间、术中出血量、术后引流量及愈合时间均明显多于PFN组（P<0.01）；DHS组、PFN组A1、A2型骨折术后各时间点Harris评分差异均无统计学意义（P>0.05）；DHS组A3型骨折术后各时间点Harris评分均明显低于PFN组（P<0.01）；2组术后1、3、6个月疼痛VAS评分均明显低于术前（P<0.01），2组间VAS评分差异均无统计学意义（P>0.05）；PFN组A3型骨折患者的肺栓塞1例。结论：对于A1、A2型老年股骨转子间骨折PFN、DHS治疗均能取得满意疗效；对于A3型股骨转子间骨折，PFN具有更好的力学稳定性，效果优于DHS。Abstract: Objective: To investigate the clinical efficacy of proximal femoral nail(PFN) and dynamic hip screw(DHS) treatment of intertrochanteric fracture.Methods: One hundred and fifty-eight cases of intertrochanteric fractures in elderly patients were selected as research subjects,which 128 cases were treated with DHS,30 cases were treated with PFN.Treatment effect of two surgery was compared.Results: There was no statistical difference about the operation time,blood loss,postoperative drainage,and healing time,between the group of DHS and PFN of A1,A2 patients with fractures(P>0.05);The Operative time,blood loss,amount of postoperative drainage and healing time in group of DHS patients with type A3 fracture were significantly more than in group of PFN(P<0.01);postoperative Harris scores in type of A1 and A2 fractures at each time point had no statistical difference between group DHS and PFN(P>0.05);The postoperative Harris scores of A3 fractures in group of DHS were significantly lower than that in group of PFN at each time point(P<0.01);Pain VAS scores of each group 1 month,3 months,6 months postoperative were significantly lower than preoperative(P<0.01),There was no statistical difference between the VAS scores of all groups(P>0.05);1 case of pulmonary embolism happened in group of PFN patients with A3 fracture.Conclusions: PFN,DHS has achieved satisfactory results for A1,A2 senile intertrochanteric fracture;Among A3 for intertrochanteric fracture,PFN has better mechanical stability,the effect is better than DHS.
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Key words:
- femoral fractures /
- proximal femoral nail /
- dynamic hip screw /
- Harris score
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