InterTAN、PFNA、DHS治疗不稳定性股骨粗隆间骨折的比较  

Comparison of InterTAN,PFNA and DHS for unstable femoral intertrochanteric fractures

作　　者：林荣侯 刘勇 隋丽娟 张雪涛 隋志强 王蕾 LIN Rong-hou;LIU Yong;SUI Li-juan;ZHANG Xue-tao;SUI Zhi-qiang;WANG Lei(Department of Surgery,Weifang Medical University,Weifang 261053,China;Institute of Orthopaedics,The 80th Army Hospital of PLA,Weifang 261053,China)

机构地区：[1]潍坊医学院外科学教研室,山东潍坊261053 [2]陆军第八十集团军医院骨科研究所

出　　处：《中国矫形外科杂志》2020年第6期507-511,共5页Orthopedic Journal of China

摘　　要：[目的]对比分析InterTAN髓内钉、股骨近端防旋髓内钉(PFNA)、动力髋螺钉(DHS)内固定治疗不稳定性股骨粗隆间骨折的临床疗效。[方法]回顾性分析诊治的120例不稳定性股骨粗隆间骨折患者,InterTAN组40例,PFNA组40例,DHS组40例。比较三组围手术期、随访和影像资料。[结果]手术时间、术中失血量、切口长度和住院时间由小到大依次为PFNA<InterTAN<DHS,差异有统计学意义(P<0.05)。三组患者随访6~13个月,平均(10.50±1.51)个月。三组患者均随术后时间延长,疼痛减轻,功能改善。完全负重行走时间依次为PFNA<InterTAN<DHS,差异有统计学意义(P<0.05)。末次随访时VAS评分由小到大依次为PFNA<InterTAN<DHS,差异有统计学意义(P<0.05);但是,Harris评分和髋伸屈ROM由大到小依次为InterTAN>PFNA>DHS,差异有统计学意义(P<0.05)。术后影像显示骨折复位质量三组间差异无统计学意义(Z=1.574,P=0.455)。至末次随访时,InterTAN组和PFNA组患者骨折均愈合,而DHS组中,4例骨不愈合。随访过程中,InterTAN组发生1例螺钉退出;PFNA组发生4例螺旋刀片切割或退出、2例髋内翻;DHS组发生6例螺钉退出、3例钢板断裂、4例髋内翻。DHS组晚期并发症率显著高于InterTAN和PFNA组(P<0.05)。[结论]InterTAN与PFNA内固定治疗不稳定股骨粗隆间骨折疗效显著优于DHS内固定,而InterTAN的优势更加显著。[Objective]To compare the clinical outcomes of InterTAN intramedullary nailing,proximal femoral nail anti-ro tation(PFNA)and dynamic hip screw(DHS)for internal fixation of unstable intertrochanteric fractures.[Methods]A retrospec tive study was performed on 120 patients who underwent surgical treatment for unstable intertrochanteric fracture.Based on in ternal fixations used,40 patients had fractures fixed with InterTAN,40 patients with PFNA and 40 patients with DHS.The Peri operative,follow-up and radiographic data were compared among the three groups.[Results]The sequences down-up regarding to operation time,intraoperative blood loss,incision length and hospital stay were of PFNA<InterTAN<DHS,which were statisti cally significant(P<0.05).All the patients were followed up for 06~13 months with an average of(10.50±1.51)months.As time went postoperatively,the patients got pain relief and functional improvements gradually.The full-weight bearing time was ranked as PFNA<InterTAN<DHS with a statistical significance among the 3 groups(P<0.05).At the latest follow up,the VAS score was arranged down-up as InterTAN<PFNA<DHS with a statistical significance(P<0.05),whereas the extension-flexion ROM and Harris score were ranked up-down as InterTAN>PFNA>DHS with statistical significances(P<0.05).In term of radio graphic evaluations,there was no a statistical significant difference in quality of fracture reduction among the 3 groups revealed by postoperative images(P>0.05).To the latest follow up,all patients in the InterTAN group and PFNA group achieved bony healing,whereas 4/40 in the DHS group proved of nonunion.During the period of follow up,the InterTAN group had only 1 pa tients suffered from screw withdrawing,the PFNA group had 4 cases of blade loosening and 2 cases of coxa vara,whereas the DHS group got 6 cases of screw loosening,3 cases of plate breaking and 4 cases of coxa vara.The incidence of late com plication radiographically revealed in the DHS group proved significantly higher than in the InterTAN and PFNA gr

关 键 词：股骨粗隆间骨折 INTERTAN 髓内钉 股骨近端防旋髓内钉 动力髋螺钉 

分 类 号：R683.42[医药卫生—骨科学]