目的 比較防旋股骨近端髓內(nèi)釘（proximal femoral nail antirotation，PFNA）與動力髖螺釘（dynamic hip screw，DHS）固定治療老年股骨粗隆間骨折的療效。 方法 2007 年5 月－ 2010 年5 月，收治63 例老年股骨粗隆間骨折患者。根據(jù)內(nèi)固定方法不同將患者分為兩組，其中31 例采用PFNA 內(nèi)固定（PFNA 組）， 32 例采用DHS 內(nèi)固定（DHS組）。兩組患者性別、年齡、致傷原因、病程及骨折類型等一般資料比較，差異均無統(tǒng)計學意義（P gt; 0.05），具有可比性。 結果 術后兩組切口均Ⅰ期愈合。PFNA 組切口長度、手術時間及術中出血量均顯著少于DHS 組（P lt; 0.05）。患者術后均獲隨訪，PFNA 組平均隨訪時間13.6 個月，DHS 組平均13.8 個月。兩組骨折均愈合，其中PFNA 組骨折愈合時間為（11.80 ± 1.32）周，早于DHS 組的（12.21 ± 1.26）周，但差異無統(tǒng)計學意義（t=1.23，P=0.29）。PFNA 組并發(fā)癥發(fā)生率為0，DHS 組為12.5%（4/32），但差異無統(tǒng)計學意義（P=0.06 ）。術后1 年PFNA 組Harris 髖關節(jié)評分為（86.55 ± 10.32）分，優(yōu)于DHS組的（80.36 ± 11.18）分（t=2.28，P=0.03）。 結論 PFNA 及DHS 治療老年股骨粗隆間骨折各有優(yōu)勢，對于不穩(wěn)定型骨折宜選用PFNA 治療。
引用本文： 沈光銀. 防旋股骨近端髓內(nèi)釘與動力髖螺釘治療老年股骨粗隆間骨折療效比較. 中國修復重建外科雜志, 2012, 26(6): 671-674. doi: 復制
| 1. | Brauer CA, Coca-Perraillon M, Cutler DM, et al. Incidence and mortality of hip fractures in United States. JAMA, 2009, 302(14): 1573-1579. |
| 2. | Hsueh KK, Fang CK, Chen CM, et al. Risk factors in cutout of sliding hip screw in intertrochanteric farctures: an evaluation of 937 patients. Int Orthop, 2010, 34(8): 1273-1276. |
| 3. | Jensen JS. Classification of trochanteric fractures. Acta Orthop Scand, 1980, 51(5): 803-810. |
| 4. | Baumgaertner MR, Curtin SL, Lindskog DM, et al. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg (Am), 1995, 77(7): 1058-1064. |
| 5. | Güven M, Yavuz U, Kadio?lu B, et al. Importance of screw position in intertrochanteric femoral fractures treated by dynamic hip screw. Orthop Traumatol Surg Res, 2010, 96(1): 21-27. |
| 6. | 陳柯, 劉立云. 動力髖螺釘和防旋股骨近端髓內(nèi)釘治療老年骨質疏松性股骨轉子間骨折的早期療效評價. 中國矯形外科雜志, 2011, 19(10): 801-803. |
| 7. | 方大標, 王秋根, 張秋林, 等. 醫(yī)源性因素對DHS治療髖部骨折療效的影響. 中華創(chuàng)傷骨科雜志, 2004, 6(5): 525-528. |
| 8. | 張經(jīng)緯, 蔣垚, 張先龍, 等. 股骨轉子間骨折不同手術方法比較. 中華骨科雜志, 2005, 25(1): 7-11. |
| 9. | Palm H, Jacobsen S, Sonne-Holm S, et al. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation. J Bone Joint Surg (Am), 2007, 89(3): 470-475. |
| 10. | 李必奎, 陳周兵, 徐富生. 股骨近端鎖定鋼板治療股骨轉子間骨折. 中國修復重建外科雜志, 2011, 25(10): 1273-1275. |
| 11. | Wong TC, Chiu Y, Tsang WL, et al. A double-blind, prospective, randomised, controlled clinical trial of minimally invasive dynamic hip scvew fixation of intertrochanteric fractures. Injury, 2009, 40(4): 422-427. |
| 12. | Xu YZ, Geng D, Yang H, et al. Treatment of unstable proximal femoral fractures: comparion of the proximal femoral nail antirotation and gamma nail. Orthopedics, 2010, 33(7): 473. |
| 13. | Takigami I, Matsumoto K, Ohara A, et al. Treatment of trochanteric fractures with the PFNA (proximal femoral nail antirotation) nail system——report of early results. Bull NYU Hosp Jt Dis, 2008, 66(4): 276-279. |
| 14. | Mereddy P, Kamath S, Ramakrishnan M, et al. The AO/ASIF proximal femoral nail antirotation (PFNA): a new desigen for the treatment of unstable proximal femoral fractures. Injury, 2009, 40(4): 428-432. |
| 15. | Strauss E, Frank J, Lee J, et al. Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip hip fractures: a biomechanical evaluation. Injury, 2006, 37(10): 984-989. |
| 16. | 秦暉, 安智全. InterTan治療股骨粗隆間骨折的療效評估. 中國修復重建外科雜志, 2010, 24(12): 1424-1427. |
| 17. | Haidukewych GJ. Intertrochanteric fractures: ten tips to improve results. J Bone Joint Surg (Am), 2009, 91(3): 712-719. |
| 18. | Ostrum RF, Levy MS. Penetration of the distal femoral anterior cortex during intramedullary nailing for subtrochanteric fractures: a report of three cases. J Orthop Trauma, 2005, 19(9): 656-660. |
- 1. Brauer CA, Coca-Perraillon M, Cutler DM, et al. Incidence and mortality of hip fractures in United States. JAMA, 2009, 302(14): 1573-1579.
- 2. Hsueh KK, Fang CK, Chen CM, et al. Risk factors in cutout of sliding hip screw in intertrochanteric farctures: an evaluation of 937 patients. Int Orthop, 2010, 34(8): 1273-1276.
- 3. Jensen JS. Classification of trochanteric fractures. Acta Orthop Scand, 1980, 51(5): 803-810.
- 4. Baumgaertner MR, Curtin SL, Lindskog DM, et al. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg (Am), 1995, 77(7): 1058-1064.
- 5. Güven M, Yavuz U, Kadio?lu B, et al. Importance of screw position in intertrochanteric femoral fractures treated by dynamic hip screw. Orthop Traumatol Surg Res, 2010, 96(1): 21-27.
- 6. 陳柯, 劉立云. 動力髖螺釘和防旋股骨近端髓內(nèi)釘治療老年骨質疏松性股骨轉子間骨折的早期療效評價. 中國矯形外科雜志, 2011, 19(10): 801-803.
- 7. 方大標, 王秋根, 張秋林, 等. 醫(yī)源性因素對DHS治療髖部骨折療效的影響. 中華創(chuàng)傷骨科雜志, 2004, 6(5): 525-528.
- 8. 張經(jīng)緯, 蔣垚, 張先龍, 等. 股骨轉子間骨折不同手術方法比較. 中華骨科雜志, 2005, 25(1): 7-11.
- 9. Palm H, Jacobsen S, Sonne-Holm S, et al. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation. J Bone Joint Surg (Am), 2007, 89(3): 470-475.
- 10. 李必奎, 陳周兵, 徐富生. 股骨近端鎖定鋼板治療股骨轉子間骨折. 中國修復重建外科雜志, 2011, 25(10): 1273-1275.
- 11. Wong TC, Chiu Y, Tsang WL, et al. A double-blind, prospective, randomised, controlled clinical trial of minimally invasive dynamic hip scvew fixation of intertrochanteric fractures. Injury, 2009, 40(4): 422-427.
- 12. Xu YZ, Geng D, Yang H, et al. Treatment of unstable proximal femoral fractures: comparion of the proximal femoral nail antirotation and gamma nail. Orthopedics, 2010, 33(7): 473.
- 13. Takigami I, Matsumoto K, Ohara A, et al. Treatment of trochanteric fractures with the PFNA (proximal femoral nail antirotation) nail system——report of early results. Bull NYU Hosp Jt Dis, 2008, 66(4): 276-279.
- 14. Mereddy P, Kamath S, Ramakrishnan M, et al. The AO/ASIF proximal femoral nail antirotation (PFNA): a new desigen for the treatment of unstable proximal femoral fractures. Injury, 2009, 40(4): 428-432.
- 15. Strauss E, Frank J, Lee J, et al. Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip hip fractures: a biomechanical evaluation. Injury, 2006, 37(10): 984-989.
- 16. 秦暉, 安智全. InterTan治療股骨粗隆間骨折的療效評估. 中國修復重建外科雜志, 2010, 24(12): 1424-1427.
- 17. Haidukewych GJ. Intertrochanteric fractures: ten tips to improve results. J Bone Joint Surg (Am), 2009, 91(3): 712-719.
- 18. Ostrum RF, Levy MS. Penetration of the distal femoral anterior cortex during intramedullary nailing for subtrochanteric fractures: a report of three cases. J Orthop Trauma, 2005, 19(9): 656-660.