髋外翻与髋内翻复位植入股骨近端螺旋刀片抗旋髓内钉治疗股骨转子间骨折的疗效比较  

Comparative study between Valgus reduction and Varus reduction in PFNA for femoral intertrochanteric fractures

作　　者：董锐[1] 金晓莹 汪华侨[3] DONG Rui;JIN Xiao-ying;WANG Hua-qiao(Department of orthopedics,Chuzhou First People's Hospital,Chuzhou 239000,Anhui,China;不详)

机构地区：[1]滁州市第一人民医院骨四科,安徽滁州239000 [2]滁州市第一人民医院手术室,安徽滁州239000 [3]中山大学中山医学院解剖学教研室,广东广州510632

出　　处：《广东医学》2020年第14期1464-1469,共6页Guangdong Medical Journal

摘　　要：目的比较分别在髋外翻与髋内翻复位状态下植入股骨近端螺旋刀片抗旋髓内钉(PFNA)治疗股骨转子间骨折患者的疗效。方法回顾性分析使用髋外翻复位植入PFNA治疗并获得随访的36例股骨转子间骨折患者(髋外翻复位组)资料,其中男13例,女23例,年龄66~93岁,平均(77.1±6.52)岁;选取同期髋内翻复位植入PFNA治疗股骨转子间骨折的患者31例作为对照(髋内翻复位组),其中男10例,女21例,年龄65~97岁,平均(79.4±7.93)岁。记录两组患者的股骨距参考尖顶距、手术时间、出血量、骨折愈合时间、术后髋关节Harris评分,进行统计学分析。结果髋外翻复位组和髋内翻复位组患者的随访时间分别为3~25(16.36±2.75)个月和3~27(15.92±4.04)个月;两组股骨距参考尖顶距分别为(20.31±3.55)mm和(28.59±4.76)mm,差异有统计学意义(t=10.421,P=0.000);两组手术时间分别为(83.00±13.63)min和(101.00±12.87)min,差异有统计学意义(t=3.076,P=0.020);两组术中出血分别为(178.0±10.5)mL和(246.0±14.4)mL,差异有统计学意义(t=2.905,P=0.018)。影像学检查明确骨折愈合时间髋外翻复位组与髋内翻复位组分别为(4.68±1.92)个月和(6.34±2.18)个月,差异有统计学意义(t=1.605,P=0.027)。两组术后3个月Harris髋关节评分分别为(68.7±5.3)分和(51.8±7.1)分,差异有统计学意义(t=4.291,P=0.000);两组术后VAS评分差异无统计学意义(P>0.05)。结论髋外翻复位方法能够更加精准地植入头内钉,避免了反复操作,对组织损伤小;应用髋外翻复位方法的PFNA治疗股骨转子间骨折比髋内翻复位可获得更加满意的头内钉位置和临床治疗效果。Objective To compare the clinical effects of valgus reduction with varus reduction for PFNA in femoral intertrochanteric fractures.Methods 67 patients with femoral intertrochanteric fractures received PFNA were retrospectively analyzed in our Hospital.Hip valgus reduction was performed in 36 patients,including 13 males and 23 females,aged between 66 and 93 years(77.1±6.52 years);and 31 patients received hip varus reduction,including 10 males and 21 females,aged between 65 and 97 years(79.4±7.93 years).The hip valgus reduction was defined as neck stem angle between 130°and 145°,neck stem angle less than 120 degrees is defined as hip varus reduction.The operation length,bleeding volume,calcar referenced tip-apex distance,fracture healing time,and postoperative harris hip score were compared between the two groups.Results All of 67 patients were followed up for 3-27 months,with an average of 18.2 months.The calcar referenced tip-apex distance of the valgus reduced group was 20.31±3.55 mm and of the varus reduced group was 28.59±4.76 mm(t=10.421,P=0.000).The mean operation length of valgus reduced group was 83±13.63 min,and that of varus reduced group was 101±12.87 min(t=3.076,P=0.020).The blood loss of valgus reduced group was 178±10.5 mL,and that of varus reduced group was 246±14.4 mL(t=2.905,P=0.018).The average healing time was 4.68±1.92 months in valgus reduced group and 6.34±2.18 months in varus reduced group(t=1.605,P=0.027).Three months after operation,the harris hip score of valgus reduced group was 68.7±5.3,and that of the valgus reduced group was 51.8±7.1(t=4.291,P=0.000).All these parameters had statistical significant difference between the 2 groups(P<0.05).But there was no significant difference in the VAS score between the 2 groups.Conclusion Valgus reduction provides less local trauma,less damage to the femoral head,good position of the blade at the femoral head and reliable fixation in PFNA for femoral intertrochanteric fractures.

关 键 词：转子间骨折 髋 外翻复位 股骨距参考尖顶距 对比研究 

分 类 号：R683.42[医药卫生—骨科学] R323.45[医药卫生—外科学]