股骨近端防旋髓内钉内固定治疗老年不稳定型股骨转子间骨折中螺旋刀片位置的研究  

Effect of screw blade position on proximal femoral nail anti-rotation internal fixation for unstable intertrochanteric fractures in the elderly

作　　者：曾锦源[1] 叶君健[1] 谢昀[1] 陈春永[1] 林章雄[1] ZENG Jinyuan;YE Junjian;XIE Yun;CHEN Chunyong;LIN Zhangxiong(Department of Orthopaedic Trauma,the First Affiliated Hospital of Fujian Medical University,Trauma Center of Fujian,Fuzhou Fujian,350005,P.R.China)

机构地区：[1]福建医科大学附属第一医院创伤骨科福建省创伤医学中心,福州350005

出　　处：《中国修复重建外科杂志》2020年第5期569-573,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)内固定治疗老年不稳定型股骨转子间骨折术中螺旋刀片位置对疗效的影响。方法回顾分析2010年1月—2017年1月经PFNA内固定治疗的131例老年不稳定型股骨转子间骨折患者临床资料。其中72例患者正位X线片显示螺旋刀片位于股骨颈中间(A组)、59例位于股骨颈中下1/3(B组)。两组患者性别、年龄、骨密度、骨折分型、合并内科疾病及受伤至手术时间等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。比较两组并发症发生情况、髋关节功能Harris评分、骨折愈合情况以及尖顶距(tip-apex distance,TAD)、尾钉高度。结果两组患者术后均获随访,随访时间11~14个月,平均12.1个月。术后患者切口均Ⅰ期愈合,均无相关并发症发生。两组骨折均达临床骨性愈合,愈合时间组间比较差异无统计学意义(Z=?0.190,P=0.849)。术后6个月,A组TAD为(2.23±0.07)cm、尾钉高度为(1.72±0.14)cm,B组分别为(2.85±0.12)、(0.53±0.26)cm,两组间差异有统计学意义(t=?47.643,P=0.000;t=31.031,P=0.000)。术后6个月,A组髋关节功能获优48例、良15例、可9例,B组获优38例、良16例、可5例,组间差异无统计学意义(Z=?0.075,P=0.941)。结论PFNA内固定治疗老年不稳定型股骨转子间骨折时,结合适宜的TAD,螺旋刀片置于股骨颈中间或中下1/3均可获得较好疗效。Objective To investigate the effect of the screw blade position on the effectiveness of proximal femoral nail anti-rotation(PFNA)internal fixation for unstable intertrochanteric fractures in the elderly.Methods A clinical data of 131 elderly patients with unstable intertrochanteric fractures who were treated with PFNA internal fixation between January 2010 and January 2017 was retrospectively analyzed.According to the anteroposterior X-ray films,the screw blades were placed in the middle of the femoral neck in 72 patients(group A)and at one-third of the femoral neck in 59 patients(group B).There was no significant difference between the two groups(P>0.05)in the gender,age,bone density,classification of fractures,other medical diseases,and the time between injury and operation.Multiple treatment indexes were analyzed,including complications,hip Harris score,the healing status of fracture,tip-apex distance(TAD),and the height of the tail nail.Results All patients were followed up 11-14 months,with an average of 12.1 months.All incisions healed by first intention with no complications.All fractures healed and no significant difference in bone healing time between the two groups(Z=?0.190,P=0.849).At 6 months after operation,TAD was(2.23±0.07)cm in group A and(2.85±0.12)cm in group B,showing significant difference(t=?47.643,P=0.000);and the height of the tail nail was(1.72±0.14)cm in group A and(0.53±0.26)cm in group B,showing significant difference(t=31.031,P=0.000).According to the Harris score,the hip functions were rated as excellent in 48 cases,good in 15 cases,and poor in 9 cases in group A,while as excellent in 38 cases,good in 16 cases,and poor in 5 cases in group B,with no significant difference between the two groups(Z=?0.075,P=0.941).Conclusion For the unstable intertrochanteric fracture in the elderly,the PFNA internal fixation with appropriated TAD and the screw blades placed in the middle or at one-third of the femoral neck can obtain good effectiveness.

关 键 词：股骨转子间骨折 不稳定型骨折 股骨近端防旋髓内钉 螺旋刀片 尖顶距 老年人 

分 类 号：R687.3[医药卫生—骨科学]