PFLP與PFNA內固定治療老年股骨粗隆間骨折療效分析

吳志忠 李生國 王璽 朱輝 黃國平 任作玉

摘 要：目的 探討股骨近端解剖型鎖定板與股骨近端髓內釘內固定治療老年股骨粗隆間骨折的臨床療效。方法 回顧性分析自2015年5月～2017年6月我院診治的70列老年股骨粗隆間骨折，按就診的先后順序隨機分為兩組，采用PFLP內固定32例，采用PFNA內固定38例。所有患者記錄骨折愈合時間、術后并發癥，并行Harris髖關節功能評分。結果 所有患者獲得隨訪6～12個月。所有患者都獲得骨性合愈，愈合時間3～6個月，平均5個月。PFNA組手術時間及術中出血量均少于PFLP組，差異有統計學意義（P<0.05）；兩組骨折愈合時間、患肢完全負重時間、住院時間比較，差異無統計學意義（P>0.05）。PFNA組術后6周按髖關節功能Harris評分優良率89.47%，優于PFLP組87.50%，差異有統計學意義（P<0.05）。結論 PFNA內固定相比PFLP內固定優勢略為明顯，但兩者都具有操作簡單，復合生物力學固定原則，術后并發癥少，療效肯定的特點，臨床上應根據骨折的具體情況與術者對固定方法的熟練程度靈活選擇運用。

關鍵詞：老年股骨粗隆間骨折；PFLP；PFNA；內固定

中圖分類號：R687.3 文獻標識碼：A DOI：10.3969/j.issn.1006-1959.2018.15.025

文章編號：1006-1959（2018）15-0082-04

PFLP and PFNA Internal Fixation for the Treatment of Intertrochanteric Fractures in the Elderly

WU Zhi-zhong，LI Sheng-guo，WANG Xi，ZHU Hui，HUANG Guo-ping，REN Zuo-yu

（Department of Orthopedics，Wuwei Hospital of Traditional Chinese Medicine，Wuwei 733000，Gansu，China）

Abstract：Objective To compare the therapeutic effects of anatomical locking plate and proximal femoral nail in the treatment of intertrochanteric fracture in the elderly.Methods From May 2015 to June 2017，70 elderly intertrochanteric fracture of femur were analyzed retrospectively.According to the order of treatment， they were randomly divided into two groups：32 cases were treated with PFLP internal fixation，38 cases were treated with PFNA internal fixation.Fracture healing time，postoperative complications and Harris score of hip joint function were recorded in all patients.Results All patients were followed up for 6 to12 months.All patients achieved bony union.The healing time was 3 to 6 months，with an average of 5 months.The operative time and intraoperative blood loss in group PFNA were less than those in group PFLP，the difference was statistically significant（P<0.05）.There was no significant difference in fracture healing time，full weight-bearing time of the affected limb and length of stay between the two groups（P>0.05）.The excellent and good rate of Harris score of hip joint function in PFNA group was 89.47%，which was superior to that in PFLP group 87.5%，the difference was statistically significant（P<0.05）.Conclusion The advantages of PFNA internal fixation are more obvious than that of PFLP，but both have the characteristics of simple operation，complex biomechanical fixation principle，less postoperative complications and positive curative effect.According to the specific condition of fracture and the skillful degree of fixation，we should choose and use it flexibly.

Key words：Intertrochanteric fracture in the elderly；PFLP；PFNA；Internal fixation

股骨粗隆間骨折（ntertrochantericfractureoffemur）是指發生于股骨頸基底部至小粗隆水平以上骨折，是囊外骨折，股骨頭的血運供應很少受影響，占股骨近端骨折的55%，主要發生在有骨質疏松的老年患者，圍手術期的死亡率高，多發生于骨質疏松的老年患者，通常有手術指征，大多病例臨床效果良好。年輕患者由高能量損傷造成，并伴有其它損傷，老年患者多為低能量損傷所致，老年股骨粗隆間骨折非手術治療由于臥床時間長骨折近遠期并發癥高，導致致殘率、病死率較高，近幾年來老年股骨粗隆間骨折采用手術方法大體有髓內固定、髓外固定二種，髓外固定主要有外固定支架、動力髖（DHS）、動力髁螺釘，股骨近端鎖釘鋼板，髓內固定主要有Gamma釘、股骨近端髓內釘等[1]，骨折斷端穩定復位及堅強固定，早期功能鍛煉是手術的目標[2]。……