DHS与PFNA在治疗老年股骨粗隆间骨折中的应用比较(1)
[摘要] 目的 探讨动力髋关节螺钉内固定(DHS)与股骨近端内固定系统(PFNA)在治疗老年股骨粗隆间骨折中的应用价值。 方法 选择36例患者使用PFNA内固定(观察组)，并与35例使用DHS的患者(对照组)比较术中出血量、手术时间以及术后伤口引流量，以及随访1年后的临床效果。 结果 观察组术中出血量、手术时间以及术后伤口引流量均显著少于对照组(P < 0.05)，观察组优良率为94.4%，对照组优良率为74.3%，观察组优良率显著高于对照组(P < 0.05)。 结论 PFNA治疗老年转子间骨折具有较为肯定的临床效果，且其手术时间短、术中出血少、术后恢复快，是一种值得推广的手术方法。
[关键词] 动力髋关节螺钉内固定(DHS)；股骨近端内固定系统(PFNA)；老年；股骨粗隆间骨折
[中图分类号] R683.42 [文献标识码] A [文章编号] 1674-4721(2012)07(b)-0035-02
, 百拇医药
The application of DHS and PFNA in the treatment of senile femoral intertrochanteric fracture
ZHUANG Wenjie
Department of Orthopaedic, the Second Affiliated Hospital of Guiyang Medical Orthopaedic, Kaili 556000, China
[Abstract] Objective To explore the value of dynamic hip screw (DHS) and proximal femoral nail antirotation (PFNA) in the treatment of elderly femoral intertrochanteric fracture. Methods There were 36 patients used PFNA (the observation group) fixed and 35 cases used DHS (the control group), the intraoperative blood loss, operative time and postoperative wound drainage, as well as the follow-up of the clinical effect after one year between two groups were compared. Results The amount of blood loss, operative time and postoperative wound drainage volume of the observation group were significantly less than those of control group (P < 0.05), excellent and good rate of the observation group was 94.4%, which of the control group was 74.3%, excellent and good rate of observation group was significantly higher than that of control group (P < 0.05). Conclusion PFNA treatment for elderly intertrochanteric fracture has a positive clinical effect with short operative time, less blood loss, rapid postoperative recovery, is a surgical methods worthy of promotion.
, http://www.100md.com
[Key words] Dynamic hip screw; Proximal femoral nail antirotation; The elderly; Intertrochanteric fracture
股骨粗隆间骨折在老年患者，尤其是老年男性患者中较为常见，其对患者的行动及生存质量等均造成极为不良的影响，其治疗主要以手术为主，其中动力髋关节螺钉内固定(DHS)与股骨近端内固定系统(PFNA)是治疗本病的较为有效的两种方法，临床中应用较多[1]。本研究主要探讨两种不同的治疗方法在老年股骨粗隆间骨折患者中的应用价值，现报道如下：
1 资料与方法
1.1 一般资料
选择2010年1月～2011年1月本院骨科收治的老年股骨粗隆间骨折患者71例，随机分为两组，观察组36例：男15例，女21例，年龄61～88岁，平均75.9岁，合并有糖尿病者11例，冠心病者15例，高血压者20例，病变部位：右侧20例、左侧16例，Evans Jensen分型：Ⅰ～Ⅱ型9例、Ⅲ型18例、Ⅳ～Ⅴ型9例；对照组35例：男16例，女19例，年龄60～87岁，平均76.1岁，合并有糖尿病者10例，冠心病者16例，高血压者21例，病变部位：右侧19例、左侧16例，Evans Jensen分型：Ⅰ～Ⅱ型8例、Ⅲ型17例、Ⅳ～Ⅴ型10例；两组患者性别、年龄、合并疾病、病变部位以及Evans Jensen分型等差异无统计学意义(P > 0.05)。
, http://www.100md.com
1.2 方法
本组患者均在全身麻醉下完成手术治疗，完善术前准备，术中取健侧卧位，行髋外侧弧形切口进入，其中对照组使用DHS内固定：充分暴露后，用1枚直径约2.5 mm的克氏针行定位临时固定，行C型臂透视确定位置后在股骨大粗隆顶点以下约3 cm处用130°导向器打入导针至股骨头软骨下0.5 cm处，确定位置合适后，使用DHS扩孔器扩空并行攻丝处理，置入DHS螺钉，保证“尖顶距”合适后固定并放置引流管、缝合、包扎；观察组使用PFNA方法：体表定位大粗隆后，在其顶端10 cm处行纵切口，置入髓腔导针，扩髓腔，并沿导针置入PFNA主钉后拔出导针，使用瞄准臂，于股骨头颈内再次置入导针，行C臂透视，确定位置后，根据导针指引向股骨头内缓慢置入螺旋刀片，并锁定后拧紧远端交锁螺和尾帽。, 百拇医药(庄文杰)
[关键词] 动力髋关节螺钉内固定(DHS)；股骨近端内固定系统(PFNA)；老年；股骨粗隆间骨折
[中图分类号] R683.42 [文献标识码] A [文章编号] 1674-4721(2012)07(b)-0035-02
, 百拇医药
The application of DHS and PFNA in the treatment of senile femoral intertrochanteric fracture
ZHUANG Wenjie
Department of Orthopaedic, the Second Affiliated Hospital of Guiyang Medical Orthopaedic, Kaili 556000, China
[Abstract] Objective To explore the value of dynamic hip screw (DHS) and proximal femoral nail antirotation (PFNA) in the treatment of elderly femoral intertrochanteric fracture. Methods There were 36 patients used PFNA (the observation group) fixed and 35 cases used DHS (the control group), the intraoperative blood loss, operative time and postoperative wound drainage, as well as the follow-up of the clinical effect after one year between two groups were compared. Results The amount of blood loss, operative time and postoperative wound drainage volume of the observation group were significantly less than those of control group (P < 0.05), excellent and good rate of the observation group was 94.4%, which of the control group was 74.3%, excellent and good rate of observation group was significantly higher than that of control group (P < 0.05). Conclusion PFNA treatment for elderly intertrochanteric fracture has a positive clinical effect with short operative time, less blood loss, rapid postoperative recovery, is a surgical methods worthy of promotion.
, http://www.100md.com
[Key words] Dynamic hip screw; Proximal femoral nail antirotation; The elderly; Intertrochanteric fracture
股骨粗隆间骨折在老年患者，尤其是老年男性患者中较为常见，其对患者的行动及生存质量等均造成极为不良的影响，其治疗主要以手术为主，其中动力髋关节螺钉内固定(DHS)与股骨近端内固定系统(PFNA)是治疗本病的较为有效的两种方法，临床中应用较多[1]。本研究主要探讨两种不同的治疗方法在老年股骨粗隆间骨折患者中的应用价值，现报道如下：
1 资料与方法
1.1 一般资料
选择2010年1月～2011年1月本院骨科收治的老年股骨粗隆间骨折患者71例，随机分为两组，观察组36例：男15例，女21例，年龄61～88岁，平均75.9岁，合并有糖尿病者11例，冠心病者15例，高血压者20例，病变部位：右侧20例、左侧16例，Evans Jensen分型：Ⅰ～Ⅱ型9例、Ⅲ型18例、Ⅳ～Ⅴ型9例；对照组35例：男16例，女19例，年龄60～87岁，平均76.1岁，合并有糖尿病者10例，冠心病者16例，高血压者21例，病变部位：右侧19例、左侧16例，Evans Jensen分型：Ⅰ～Ⅱ型8例、Ⅲ型17例、Ⅳ～Ⅴ型10例；两组患者性别、年龄、合并疾病、病变部位以及Evans Jensen分型等差异无统计学意义(P > 0.05)。
, http://www.100md.com
1.2 方法
本组患者均在全身麻醉下完成手术治疗，完善术前准备，术中取健侧卧位，行髋外侧弧形切口进入，其中对照组使用DHS内固定：充分暴露后，用1枚直径约2.5 mm的克氏针行定位临时固定，行C型臂透视确定位置后在股骨大粗隆顶点以下约3 cm处用130°导向器打入导针至股骨头软骨下0.5 cm处，确定位置合适后，使用DHS扩孔器扩空并行攻丝处理，置入DHS螺钉，保证“尖顶距”合适后固定并放置引流管、缝合、包扎；观察组使用PFNA方法：体表定位大粗隆后，在其顶端10 cm处行纵切口，置入髓腔导针，扩髓腔，并沿导针置入PFNA主钉后拔出导针，使用瞄准臂，于股骨头颈内再次置入导针，行C臂透视，确定位置后，根据导针指引向股骨头内缓慢置入螺旋刀片，并锁定后拧紧远端交锁螺和尾帽。, 百拇医药(庄文杰)