Analysis of the value of extramedullary and intramedullary fixation systems in the treatment of elderly intertrochanteric femoral fractures
髓外与髓内固定系统应用于老年股骨转子间骨折治疗的价值分析

摘要

目的 探讨不同内固定方式应用于老年股骨转子间骨折的综合疗效，对比动力髋螺钉（DHS）髓外置入与股骨近端防旋髓内钉（PFNA）髓内置入的预后差异、安全风险与医疗成本。方法 选取2023年1月-2026年1月本院50例老年患者，分别采用DHS、PFNA术式，髓外固定10例、髓内固定40例，系统比对围术期资料、髋关节Harris评分、骨愈合周期、术后不良事件及住院开支。结果 PFNA组各项手术创伤与康复指标更优，术后6个月功能优良率更高，并发症发生率更低，骨折愈合更快；DHS与股骨近端锁钉板治疗花销更低，组间差异均有统计学意义（P＜0.05）。结论 PFNA微创安全、恢复理想，多用于不稳定性骨折；DHS操作简易且经济，更适合稳定性骨折的老年患者。

Abstract

Objective To explore the comprehensive therapeutic efficacy of different internal fixation methods in the treatment of elderly intertrochanteric femoral fractures, and to compare the prognosis differences, safety risks and medical costs between the external fixation of the dynamic hip screw (DHS) and proximal femoral nail antirotation (PFNA) intramedullary implantation.
Methods From January 2023 to January 2026, 50 elderly patients in our hospital were selected and treated with the DHS and PFNA surgical methods. 10 cases received external fixation and 40 cases received intramedullary fixation. The perioperative data, hip joint Harris score, bone healing cycle, postoperative adverse events and hospital expenses were systematically compared.
Results The PFNA group had better surgical trauma and rehabilitation indicators, higher functional excellent rate at 6 months after surgery, lower complication rate and faster fracture healing; the cost of DHS and proximal femoral locking plate treatment was lower, and the differences between the groups were statistically significant (P < 0.05).
Conclusion   PFNA is minimally invasive and safe, and is ideal for unstable fractures; DHS is simple to operate and economical, and is more suitable for elderly patients with stable fractures.