两种内固定治疗老年股骨转子间骨折的疗效  

The efficacy of two kinds of internal fixation in the treatment of intertrochanteric fractures in the elderly patients

作　　者：白云鹏 沈燕国[1] 邱永敏[1] 丁菊红[1] 王健[1] BAI Yun-peng;SHEN Yan-guo;QIU Yong-min;DING Ju-hong;WANG Jian(Dept of Traumatic Orthopaedics, Pudong New Area People′s Hospital of Shanghai, Shanghai 201299, China)

机构地区：[1]上海市浦东新区人民医院创伤骨科,上海201299

出　　处：《临床骨科杂志》2020年第5期711-715,共5页Journal of Clinical Orthopaedics

基　　金：上海市浦东新区卫健委重点专科项目(编号:PWZzk2017-15)。

摘　　要：目的比较第二代股骨近端防旋髓内钉(PFNA-Ⅱ)和髋部联合加压交锁髓内钉(InterTan)治疗老年股骨转子间骨折的临床疗效。方法对114例老年股骨转子间骨折患者采用PFNA-Ⅱ(PFNA-Ⅱ组,48例)和InterTan(InterTan组,66例)治疗。比较两组手术时间、术中出血量及术后并发症发生率。术后3、6、12个月采用髋关节Harris评分评价疗效。结果手术时间、术中出血量PFNA-Ⅱ组优于InterTan组(P<0.05)。患者均获得随访,时间12~36个月。术后感染率两组比较差异均无统计学意义(P>0.05),股骨头螺钉切出、股骨颈短缩、股骨头内翻的发生率InterTan组显著低于PFNA-Ⅱ组(P<0.05)。术后3个月Harris评分InterTan组高于PFNA-Ⅱ组(P<0.05),术后6、12个月Harris评分两组比较差异均无统计学意义(P>0.05)。结论InterTan因双钉固定及内部结合钉的静力锁定等特点,固定强度更高,稳定性更好,内固定相关并发症发生率更低;PFNA-Ⅱ由于操作相对简便,手术时间短,术中出血量更少。Objective To compare the clinical efficacy of hip joint pressure interlocking intramedullary nail(InterTan)and the second generation of proximal femoral nail antirotation(PFNA-Ⅱ)in the treatment of intertrochanteric fractures in the elderly patients.Methods The 114 cases of elderly patients with intertrochanteric fractures were treated by PFNA-Ⅱ(PFNA-Ⅱgroup,48 cases)and InterTan(InterTan group,66 cases).The operation time,intraoperative blood loss,clinical complications were recorded,hip Harris function scores at 3,6 and 12 months after operation were used to evaluate the effect.Results The operation time and intraoperative blood loss of PFNA-Ⅱgroup were less than those of InterTan group(P<0.05).All patients were followed up for 12~36 months.No significant difference was observed in infection rate between the two groups(P>0.05).The incidence rate of screw cut-out,femoral neck shortening and femoral head varus in InterTan group were lower than those in PFNA-Ⅱgroup(P<0.05).Harris score at 3 months postoperation was higher in InterTan group than that of PFNA-Ⅱgroup(P<0.05).There were no significant differences between the two groups in Harris score at 6,12 months of follow-up(P>0.05).Conclusions InterTan has higher fixation strength,better stability and lower incidence rate of complications related to internal fixation than PFNA-Ⅱdue to its characteristics of double nails fixation and static locking of integrated mechanism;while PFNA-Ⅱhas shorter operation time and less intraoperative blood loss due to its relatively simple operation.

关 键 词：股骨转子间骨折 第二代股骨近端防旋髓内钉 髋部联合加压交锁髓内钉 内固定 并发症 

分 类 号：R683.42[医药卫生—骨科学] R687.33[医药卫生—外科学]