股骨近端防旋髓内钉内固定治疗股骨转子间骨折伴或不伴外侧壁骨折的临床研究  

Clinical study on the treatment of intertrochanteric fractures with or without lateral wall fractures with Asian proximal femoral nail antirotation

作　　者：马建武[1] 沈晓钟[1] 曹振宇[1] 周孝辉 MA Jian-wu;SHEN Xiao-zhong;CAO Zhen-yu;ZHOU Xiao-hui(Department of Orthopaedics,Qinghai Provincial People s Hospital,Qinghai 810000,Xining,China)

机构地区：[1]青海省人民医院骨科,青海西宁810000

出　　处：《川北医学院学报》2021年第3期302-306,共5页Journal of North Sichuan Medical College

基　　金：青海省科技厅科研基金(9632020Y0305)。

摘　　要：目的:探讨股骨近端防旋髓内钉(PFNA-II)内固定治疗股骨转子间骨折(IFF)伴或不伴外侧壁骨折的临床效果。方法:回顾性分析162例IFF伴或不伴外侧壁骨折患者相关资料,其中49例伴外侧壁骨折,记为外侧壁骨折组;另外113例不伴有外侧壁骨折,记为外侧壁完整组。所有患者均自愿接受PFNA-II固定治疗,手术方法及术后处理均相同,均获得至少12个月门诊随访资料。比较两组患者一般资料、术中指标和术后负重时间、并发症、骨折愈合时间、手术疗效等。结果:外侧壁骨折组与外侧壁完整组手术时间、出血量、切口长度、术后开始负重训练时间、住院时间比较,差异均无统计学意义(P>0.05);外侧壁骨折组术后完全负重时间、骨折愈合时长于外侧壁完整组(P<0.05);两组患者均未出现内固定断裂、骨折不愈合、骨不连,切口感染、下肢深静脉血栓(DVT)、髋内翻畸形等并发症发生率比较,差异无统计学意义(P>0.05);外侧壁骨折组骨折延迟愈合发生率高于外侧壁完整组(P<0.05)。两组患者术后6个月、12个月患髋Harris评分、优良率比较,差异无统计学意义(P>0.05)。结论:PFNA-II治疗IFF伴或不伴外侧壁骨折均可取得较好手术效果,但伴外侧壁骨折患者术后负重时间和骨折愈合时间会明显延长。Objective:To investigate the clinical effect of proximal femoral nail antirotation II(PFNA-II)in the treatment of intertrochanteric fracture(IFF)with or without lateral wall fracture.Methods:The data of 162 cases of IFF with or without lateral wall fracture were retrospectively analyzed.49 cases with lateral wall fracture were recorded as lateral wall fracture group,and 113 cases without lateral wall fracture were recorded as lateral wall stability group.All patients voluntarily received PFNA-II fixation,and the surgical methods and postoperative treatment were the same.All patients were followed up for at least 12 months.The general data,intraoperative indexes and postoperative weight-bearing time,complications,fracture healing time and surgical efficacy between the two groups was compared.Results:The statistical analysis showed that there was no significant difference in operation time,blood loss,incision length,postoperative weight-bearing training time and hospitalization time between the lateral wall fracture group and the lateral wall intact group(P>0.05).The complete weight-bearing time and fracture healing time of the lateral wall fracture group were significantly longer than those of the lateral wall fracture group(P<0.05).There was no internal fixation fracture,fracture nonunion and wound infection in the two groups.In terms of complications,there was no significant difference in the incidence of incision infection,deep venous thrombosis(DVT)and coxa vara(P>0.05).The delayed union rate of fracture in lateral wall fracture group was significantly higher than that in lateral wall intact group(P<0.05).There was no significant difference in Harris score and excellent and good rate between groups at 6 and 12 months after operation(P>0.05).Conclusion:PFNA-II can achieve good results in the treatment of IFF with or without lateral wall fractures,but the postoperative weight-bearing time and fracture healing time of patients with lateral wall fractures will be significantly prolonged.

关 键 词：股骨转子间骨折 亚洲型股骨近端防旋髓内钉 内固定 外侧壁 骨折 髋关节功能 

分 类 号：R687.3[医药卫生—骨科学]