赵大兵

[摘要] 目的 探究对老年不稳定型股骨粗隆间骨折患者实施PFNA与InterTAN的应用效果。方法 依据患者入院就诊时间将随机选取该院自2018年5月—2019年9月期间接受手术的76例老年不稳定型股骨粗隆间骨折患者随机分为试验组（n=38）与参照组（n=38），试验组患者实施PFNA内固定治疗，参照组患者实施InterTAN钉内固定治疗。分析对比两组患者的术中出血量、术后引流量、手术时间及住院时间、髋关节功能Harris评分及并发症发生情况。 结果 试验组患者术中出血量及术后引流量均比参照组少，手术时间及住院时间均比参照组短，髋关节harris评分高于参照组，且试验组患者并发症发生率（13.16%）低于参照组（34.21%），差异有统计学意义（χ2=4.659，P<0.05）。结论 PFNA内固定治疗老年不稳定型股骨粗隆间骨折手术创伤小，操作简单，可减少术后引流量，缩短手术时间及恢复周期，并发症更少，但抗骨头旋转力不如InterTAN，PFNA内固定综合治疗效果优于InterTAN钉内固定。

[关键词] 不稳定型股骨粗隆间骨折;PFNA;InterTAN;并发症;内固定

[Abstract] Objective To explore the effect of PFNA and InterTAN in elderly patients with unstable intertrochanteric fractures. Methods According to the time of admission， 76 elderly patients with unstable intertrochanteric fractures who underwent surgery in the hospital from May 2018 to September 2019 were randomly divided into a test group（n=38） and a reference group（n=38）， patients in the test group were treated with PFNA internal fixation， and patients in the reference group were treated with InterTAN nail internal fixation. Analyze and compare the intraoperative bleeding volume， postoperative drainage volume， operation time and length of stay， hip function Harris score and complications of the two groups of patients. Results Patients in the experimental group had less intraoperative blood loss and postoperative drainage than those in the reference group. The operation time and hospital stay were shorter than those in the reference group. The hip joint Harris score was higher than that in the reference group. And the incidence of complications in the test group （13.16%） was lower than the reference group （34.21%），  the difference was statistically significant（χ2=4.659， P<0.05）. Conclusion PFNA internal fixation for the treatment of unstable femoral intertrochanteric fractures in the elderly has less trauma and simple operation. It can reduce postoperative drainage， shorten the operation time and recovery period， and has fewer complications. The effect of comprehensive internal fixation is better than InterTAN nail internal fixation.

[Key words] Unstable femoral intertrochanteric fracture; PFNA; InterTAN; Complications; Internal fixation

股骨粗隆间骨折在骨科疾病较常见，老年人是发病的主要群体，其原因是老年人随年龄增长患有不同程度的骨质疏松，任何力度的碰撞都有几率引发骨折，而且有较高的致残率，尤其是不稳定性股骨粗隆间骨折[1]。采取保守治療老年不稳定型股骨粗隆间骨折治疗效果不明显且并发症较多，需要患者长期卧床，所以患者临床采取手术治疗方式较多[2-3]。医学理念改变的同时，传统髓外固定方式逐渐被髓内固定所取代，典型治疗方式有2种，即PFNA与InterTAN[4]。2种手术方式术后功能及影像学结果哪个更好在医学界一直争议不断，该文将该院76例在2018年5月—2019年9月收治的老年不稳定型股骨粗隆间骨折患者作为研究对象，探究PFNA与InterTAN的治疗效果，报道如下。……