股骨近端髓内钉InterTAN和股骨近端抗旋髓内钉治疗不稳定型股骨转子间骨折的临床回顾研究  

Clinical retrospective study of intertan and proximal femoral nail antirotation in treatment of unstable intertrochanteric fractures

作　　者：王强[1] 董利军[1] 汪正宇[1] 丁国正[1] 杨民[1] 周茂生[1] 

机构地区：[1]皖南医学院弋矶山医院骨科,安徽芜湖241000

出　　处：《中华临床医师杂志（电子版）》2015年第1期64-67,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的回顾分析股骨近端髓内钉Inter TAN和股骨近端抗旋髓内钉(PFNA)治疗不稳定型股骨转子间骨折的临床效果和手术并发症。方法选取我院自2012年1月至2013年8月手术治疗的不稳定型股骨转子间骨折患者57例,按照AO分型,A2型43例,A3型14例。分别采用Inter TAN(34例)和PFNA(23例)内固定,比较两组之间的临床效果、手术损伤和手术并发症。结果术后切口均Ⅰ期愈合,无感染及皮肤坏死等早期并发症发生。手术时间:Inter TAN组(26.1±11.5)min,PFNA组(24.2±15.5)min,无统计学差异(t=1.227,P=0.246);术中出血量:Inter TAN组(76.3±30.7)ml,PFNA组(71.5±38.5)ml,无统计学差异(t=1.362,P=0.185);术中透视次数:Inter TAN组(19.5±5.9)次,PFNA组(16.1±6.1)次,无统计学差异(t=1.779,P=0.086);总计49例获得随访,其中Inter TAN组29例,PFNA组20例,随访时间(15±4.6)个月。骨折临床愈合时间:Inter TAN组(10.6±2.8)周,PFNA组(11.2±3.5)周,无统计学差异(t=0.860,P=0.392);髋关节功能评分(Harris评分法):Inter TAN组(86.7±5.4)分,PFNA组(88.5±7.6)分,无统计学差异(t=0.712,P=0.455);术后并发症:Inter TAN组出现1例髋内翻和2例下肢深静脉血栓(并发症发生率10.3%);PFNA组出现1例髋内翻和1例下肢深静脉血栓(并发症发生率10.0%),两组并发症发生率比较无统计学差异(χ2=0.001,P=0.990)。结论 Inter TAN和PFNA均具有手术时间短、术中透视次数少、术中出血量少和术后并发症发生率低的优点,两者均适用于不稳定型股骨转子间骨折病例。Objective To compare the effects and complications of InterTAN nail versus proximal femoral nail antirotation （PFNA） in treatment of unstable intertrochanteric fractures. Methods Between January 2012 and August 2013, a total of 57 patients with unstable intertrochanteric fractures were retrospectively reviewed. According to AO classification, there were 43 cases of type A2, and 14 cases of type A3. All cases treated with InterTAN （34 patients） or PFNA （23 patients）. The clinical data of surgical trauma, postoperative function and complications of the 2 groups were statistically compared in this study. Results All incisions healed by first intention; No complications of infection and necrosis occurred. The operative time was （26.1±11.5） min in InterTAN group, and was （24.2±15.5） min in PFNA group, showing no significant difference （t=1.227, P=0.246）; Intra-operative active blood loss was （76.3±30.7） ml in InterTAN group, and was （71.5±38.5） ml in PFNA group, showing no significant difference （t=1.362, P=0.185）; Fluoroscopy frequency was （19.5±5.9） times in InterTAN group and＆amp;nbsp;（16.1±6.1） times in PFNA group, showing no significant difference （t=1.779, P=0.086）; 29 cases by InterTAN and 20 cases by PFNA had obtained follow-up （15±4.6） months. The healing time was （10.6±2.8） weeks in InterTAN group, and was （11.2±3.5） weeks in PFNA group, showing no significant difference （t=0.860, P=0.392）. The harris hip score was （86.7±5.4） in InterTAN group, and was （88.5±7.6） in PFNA group, showing no significant difference （t=0.712, P=0.455）. During the follow-up, complications occurred in 3 cases in InterTAN group and 2 cases in PFNA group. In InterTAN group, one case had hip varus, two cases had deep venous thrombosis （DVT）. In PFNA group, one case developed to hip varus and the other one had DVT. The incidence of complications was 10.3% in InterTAN group and 10.0% in PFNA group, showing no significant difference （χ2=0.001,

关 键 词：骨折固定术 髓内 内固定器 髋骨折 不稳定骨折 

分 类 号：R687.3[医药卫生—骨科学]