PFN与DHS治疗老年不稳定型股骨粗隆下骨折的疗效分析

目的：比较PFN与DHS内固定治疗老年不稳定型股骨粗隆下骨折的预后及评其疗效。方法：2002年1月至2008年1月我科共收治老年不稳定型股骨粗隆下骨折患者129例，男59例，女70例，年龄51～86岁，平均61．7岁。随机选择PFN或DHS内固定，PFN组62例，DHS组67例。比较两组的手术时间、术中出血量、术后第二天CRP值、张力侧出现骨痂时间、骨折愈合时间、Harris评分等6项指标。结果：116例获得13-48个月的随访，平均18．7月，除手术时间及Harris评分无差异外，PFN组在术中出血量、术后第二天CRP值、张力侧出现骨痂时间、骨折平均愈合时间等方面与DHS组比较有显著优势（P〈0．05）。结论：PFN内固定创伤小、术后并发症率较低，可以成为治疗老年不稳定型股骨粗隆下骨折的主要方法。

Comparison of of Proximal Femoral Nail and Dynamic Hip Screw in Treatment of Subtrochanteric Unstable Fractures of Femur in Elder Patients

Objective： To compare the prognosis of the proximal femoral nail （PFN） and the dynamic hip screw （DHS） in the treatment of subtrochanteric unstable fractures of femur in elder patients. Methods： From January 2002 to January 2008, 129 patients were treated with unstable fractures of femur （59 males and 70 females） with an average age of 61.7 years ranging from 51 to 86 years. The patients were randomly divided into PFN group （n=62） and DHS group （n=67）. The operative duration, volume of blood loss, CRP value of postoperative day, callus growth time, fracture healing time and Harris Hip Score were statistically analyzed and compared between the two groups. Results： A total of 116 cases were followed up for 13 to 48 months （average 18.7 months）. There was no difference between the two groups in operative duration and Harris Hip Score. But compared with the DHS group, PFN group showed significant advantages in indicators of volume of blood loss, CRP value of postoperative day, callus growth time and fracture healing time （P〈0.05）. Conclusion： With the excellence of fewer trauma and complications, PFN treatment could be primarily used in treating the subtrochanteric unstable fractures of femur in elder patients.