InterTAN与PFNA-Ⅱ髓内固定系统在老年髋部骨折中的临床疗效分析  

InterTAN versus PFNA-Ⅱ intramedullary nailing in the treatment of geriatric femoral intertrochanteric fractures

作　　者：王喆[1] 李盛龙[2] 汤欣[3] 李骁腾 王秀会 郭胜洋 陈韬[3] 黄辽江[3] 张德强[3] Wang Zhe;Li Shenglong;Tang Xin;Li Xiaoteng;Wang Xiuhui;Guo Shengyang;Chen Tao;Huang Liaojiang;Zhang Deqiang(Department of Orthopedics, ZhongShan Hospital Affiliated to Fudan University, Shanghai 200032, China;Department of Bone and Soft Tissue Tumor Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang 110042, China;Department of Orthopedic Trauma, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China;Department of Orthopedics, Pudong New District Zhoupu Hospital, Shanghai 201318, China)

机构地区：[1]复旦大学附属中山医院骨科,上海200032 [2]中国医科大学肿瘤医院辽宁省肿瘤医院骨与软组织外科,沈阳110042 [3]大连医科大学附属第一医院创伤骨科,116011 [4]上海市浦东新区周浦医院骨科,201318

出　　处：《中华老年骨科与康复电子杂志》2017年第4期216-222,共7页Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)

摘　　要：目的比较联合加压交锁髓内钉系统(InterTAN)及股骨近端抗旋髓内钉(PFNA-Ⅴ)在老年转子间骨折的临床疗效及预后评价。方法回顾性分析3个中心(大连医科大学附属第一医院创伤骨科,中国医科大学附属肿瘤医院骨与软组织外科以及上海市健康医学院附属周浦医院骨科)2008年12月至2015年1月收治的符合纳入排除标准的股骨转子间骨折患者资料363例,按照内固定材料不同分为InterTAN组(IT组,n=188)以及PFNA-Ⅴ组(PA组,n=175)。采用独立功能评分(FIM)系统、坐位起立-行走时间(TUG)评分系统以及Harris评分系统进行功能评价以及疗效评定,随访并比较两组患者在术后出院时、出院6 w、3个月、6个月、12个月及24个月各指标的变化。结果 236例患者获得完整随访,随访率为65%,随访时间为24~74个月,平均(36±18)个月。IT组患者2年死亡率[35.1%(66/188)]与PA组[34.8%(61/175)]相比,差异无统计学意义。IT组患者手术时间及术中累计透视时间[(63±31)min、(5.8±1.8)s]均高于PA组患者[(42±28)min、(3.1±1.2)s],差异具有统计学意义(t=0.844,t=2.995;P<0.05)。42例患者接受"二次手术"治疗(IT组23例,PA组19例)(12.23%vs 10.85%),但组间差异无统计学意义。两组患者"在二次手术"的方式比较,差异具有统计学意义(t=0.851,P<0.05)。两组下肢短缩>2 cm、内固定周围骨折、同侧股骨远端骨折、同侧股骨头骨折比较,差异具有统计学意义(χ~2=2.041,χ~2=1.682,χ~2=4.063,χ~2=-5.948,P<0.05)。两组患者在术后24个月的随访中FIM评分、TUG评分以及Harris髋关节评分比较差异无统计学意义。结论两种髓内固定系统在两年随访中临床疗效以及预后评价基本一致,而InterTAN治疗活动能力较强且不稳定型转子间骨折的老年患者较PFNA能够更有效的降低术后并发症,提高临床治疗效果。Objective To compare the clinical efficacy and prognosis between two types of intramedullary nailings(InterTAN vs PFNA-Ⅱ)in the treatment of geriatric femoral intertrochanteric fractures.Methods A retrospective analysis was conducted including500cases selected from3medical centers(The First Affiliated Hospital of Dalian Medical University,Department of Bone and Soft Tissue Tumor Surgery,Cancer Hospital of China Medical University,Liaoning Cancer Hospital&Institute,Department of Orthopedics,Shanghai Zhoupu Hospital affiliated to Shanghai University of Medicine&Health Science)diagnosed as intertrochanteric fractures from Dec.2008to Jan.2015,363cases were followed up completely for2years and were divided into IT group(188cases)and PA group(175cases)according to different treatments.Pre-operative,hospital-stay and post-operative surgery-related indexes,Functional Independence Measure(FIM),Time UP and Go test(TUG)and Harris scoring system for hip function were applied for on clinical evaluation and functional recovery at discharge,6weeks,3months,6months,1year and2years postoperatively.=Results236cases were completely followed up for24to74month(35.52±17.88monthes),the rate of complete follow-up was65%.2-year mortality in IT group(66/188)were no significantly different from that in PA group[35.1%(66/188)vs34.8%(61/175)].Operative time[(63±31)vs(42±28)mins]and intra-operative fluoroscopic time[(5.8±1.8)vs(3.1±1.2)secs]were found significantly difference in2groups(t=-0.844,t=2.995;P<0.05).Forty-two cases had underwent“re-operation”for implant-related revisions and fracture fixation,but there was no significant difference between IT group(23cases,12.23%)and PA group(19cases,10.85%).However,type of re-operation were found significantly different(t=0.851,P<0.05)between2groups.As for post-operative complication,shortening greater than2cm,perio-prothestic fractures,ipslateral distal femoral fractures and femoral head fractures were significantly difference(c2=2.041,c2=1.682,c2=4.063,c2=-5.948,P<0.05).There was no si

关 键 词：髋骨折 骨折固定术 髓内 INTERTAN PFNA-II 

分 类 号：R687.3[医药卫生—骨科学]