DHS、PFNA、InterTan內固定三種術式對老年不穩定股骨粗隆間骨折的遠期療效比較

馮皓 余玲敏 王衛國

[摘要]目的 探討動力髖螺釘（DHS）、股骨近端內固定系統（PFNA）、新型股骨近端髓內釘（InterTan）內固定對老年不穩定股骨粗隆間骨折（IFF）的遠期療效比較。方法 選取2017年6月～2019年7月我院收治的90例老年不穩定IFF患者，依據雙盲法分為A、B、C組，每組各30例，A組行DHS，B組行PFNA，C組行InterTan內固定治療。比較三組患者的手術指標（手術用時、切口長度、術中出血量、骨折愈合時間）;術后隨訪半年，比較三組患者的髖關節功能（以Harris評分評定）與不良反應發生情況。結果 B組患者的手術用時和骨折愈合時間短于A、C組，切口長度短于A、C組，術中出血量少于A、C組，差異均有統計學意義（P<0.05）;C組患者的手術用時和骨折愈合時間短于A組，切口長度短于A組，術中出血量少于A組，差異均有統計學意義（P<0.05）。三組患者術前的Harris評分比較，差異無統計學意義（P>0.05）;術后半年，三組患者的Harris評分均高于術前，差異有統計學意義（P<0.05）;術后半年，C組患者的Harris評分高于A、B組，差異有統計學意義（P<0.05）;術后半年，B組患者的Harris評分高于A組，差異有統計學意義（P<0.05）。B、C組患者的不良反應總發生率均低于A組，差異有統計學意義（P<0.05），B組患者的不良反應總發生率與C組比較，差異無統計學意義（P>0.05）。結論 老年不穩定IFF患者采用PFNA治療的效果更佳，可有效提升髖關節功能并降低術后不良反應總發生率，是較佳的治療方式，值得臨床推廣應用。

[關鍵詞]不穩定股骨粗隆間骨折;動力髖螺釘;股骨近端內固定系統;新型股骨近端髓內釘

[中圖分類號] R683.42 ? ? ? ? ?[文獻標識碼] A ? ? ? ? ?[文章編號] 1674-4721（2020）9（c）-0037-04

[Abstract] Objective To investigate the long-term efficacy of dynamic hip screw （DHS）， proximal femoral nail antirotation （PFNA） and new proximal femoral intramedullary nail （InterTan） internal fixation in senile unstable intertrochanteric femoral fracture （IFF）. Methods A total of 90 senile patients with unstable IFF admitted in our hospital from June 2017 to July 2019 were selected as the research subjects and divided into groups A， B and C according to double blind method， with 30 cases in each group. Group A was treated with DHS， group B was treated with PFNA， and group C was treated with InterTan internal fixation. The surgical indexes （operation time， length of incision， intraoperative bleeding volume， fracture healing time） were compared among the three groups. The hip joint function （evaluated by Harris score） and the incidence of adverse reactions were compared among the three groups after six months of postoperative follow-up. Results The operation time and fracture healing time of group B were shorter than those of group A and C， the incision length was shorter than that of group A and C， the intraoperative blood loss was less than that of group A and C， and the differences were statistically significant （P<0.05）. The operation time and fracture healing time of group C were shorter than those of group A， the incision length was shorter than that of group A， the intraoperative blood loss was less than that of group A， and the differences were statistically significant （P<0.05）. There were no statistically significant differences in Harris scores before operation among the three groups （P>0.05）. The Harris scores of the three groups after six months of operation in all three groups were higher than those before operation， and the differences were statistically significant （P<0.05）. The Harris score of group C was higher than that in the group A and B， and the difference was statistically significant （P<0.05）. The Harris scores of group B was higher than that of group A， and the difference was statistically significant （P<0.05）.The total incidence of adverse reactions of group B and C was lower than that in the group A， and the difference was statistically significant （P<0.05）. There was no statistically significant difference in total incidence of adverse reactions between group B and C （P>0.05）. Conclusion PFNA in treatment of senile patients with unstable IFF has better curative effect， it can effectively increase hip joint function and reduce the total incidence of adverse reactions， and it is the better treatment method， which is worthy of clinical promotion and application.

[Key words] Unstable intertrochanteric femoral fracture; Dynamic hip screw; Proximal femoral nail antirotation; New proximal femoral intramedullary nail

股骨粗隆間骨折（IFF）是較為常見的一種骨科疾病，由于粗隆部血運豐富，骨折后極少不愈合，但易發生髖內翻，高齡患者長期臥床引起的并發癥較多，臨床表現為局部疼痛腫脹以及行動受限，嚴重影響老年患者的日常生活[1-2]。目前多主張采用手術治療，可最大程度改善患者的髖部功能，其中動力髖螺釘（DHS）、股骨近端內固定系統（PFNA）、新型股骨近端髓內釘（InterTan）內固定為目前臨床用于治療IFF的常用手術方法，均取得良好臨床效果，但患者由于長期臥床可引起多種并發癥，且不同治療方式其效果差別較大，目前醫學界關于對比三種術式遠期療效的專項研究并不多[3-4]。……