有限切开与闭合髓内钉固定A3型股骨粗隆间骨折  

Limited-open versus closed reduction and intramedullary nail for OA/OT A3 femoral intertrochanteric fractures

作　　者：李景光 程后庆 王林[2] 章平治 LI Jing-guang;CHENG Hou-qing;WANG Lin;ZHANG Ping-zhi(Department of Orthopaedics,The First Affiliated Hospital,Anhui College of Traditional Chinese Medicine,Wuhu 241000,China;Department of Orthopaedics,Yijishan Hospital,Wannan Medical College,Wuhu 241000,China)

机构地区：[1]安徽省中医药高等专科学校附属医院,安徽芜湖241000 [2]皖南医学院弋矶山医院,安徽芜湖241000

出　　处：《中国矫形外科杂志》2021年第18期1643-1647,共5页Orthopedic Journal of China

基　　金：安徽省高校自然科学研究重点项目(编号:KJ2019A1088)。

摘　　要：[目的]比较有限切开与闭合复位股骨近端防旋髓内钉(proximal femoral nail anti-rotation, PFNA)治疗AO/OT A3型股骨粗隆间骨折的临床效果。[方法]回顾性分析2014年6月—2019年10月采用PFNA治疗的55例AO/OT A3型股骨粗隆间骨折患者的临床资料,其中,26例采用有限切开,29例采用闭合复位。比较两组围手术期、随访和影像资料。[结果]与闭合组相比,有限切开组切口长度、术中失血量显著增大,但手术时间显著缩短、术中透视次数显著减少。所有患者随访12个月以上。晚期并发症率,有限切开组为3.85%(1/26),闭合组为37.93%(11/29),差异有统计学意义(P<0.05)。有限切开组下地行走和完全负重活动时间均显著早于闭合组(P<0.05)。术后随时间推移,两组VAS评分显著减少,而Harris评分显著增加(P<0.05);术后3个月,有限切开组VAS评分和Harris评分均显著优于闭合组(P<0.05)。影像方面,依据改良Baumgaertner骨折复位标准,有限切开组骨折复位质量显著优于闭合组(P<0.05)。两组患者骨折愈合时间的差异无统计学意义(P>0.05)。末次随访时,有限切开组的股骨颈干角和尖顶距均优于闭合组,但差异无统计学意义(P>0.05)。[结论]有限切开PFNA治疗AO/OT A3型股骨粗隆间骨折可获得更好的骨折复位与固定效果。[Objective] To compare the clinical outcomes of limited-open versus closed reduction and fixation with proximal femoral nail anti-rotation(PFNA) for AO/OT A3 femoral intertrochanteric fractures(FIFs). [Methods] From June 2014 to October 2019, 55 patients underwent PFNA for AO/OT A3 FIFs in our hospital. Among them, 26 patients were treated by the limited-open technique, while the remaining 29 patients had PFNA performed by the conventional closed technique. The documents regarding to perioperative period, followup and images were compared between the two groups. [Results] Compared with the closed group, the limited-open group had significantly greater incision length and intraoperative blood loss(P<0.05), whereas significantly less operation time and the number of intraoperative fluoroscopy(P<0.05). All the patients were followed up for more than 12 months. The late complication rate was 3.85%(1/26) in the limited-open group, whereas 37.93%(11/29) in the closed group, which was statistically significant(P<0.05). The limited-open group resumed walking and full weight-bearing activities significantly earlier than the closed group(P<0.05). The VAS score decreased significantly,while the Harris score increased significantly in both groups over time postoperatively(P<0.05). At 3 months after operation, the limitedopen group was significantly better than the closed group in both the VAS score and Harris score(P<0.05). With respect of radiographic assessment, the limited-open group got significantly better quality of fracture reduction than the closed group based on the modified Baumgaertner’s criteria(P<0.05), although there was no significant difference in fracture healing time between the two groups(P>0.05).At the latest follow-up, the limited-open group was superior to the closed group in terms of neck shaft angle(NSA) and tip-apex distance(TAD), nevertheless the difference in NSA and TAD between the two groups was not statistically significant(P>0.05). [Conclusion] The PFNA by limited-open technique does improve

关 键 词：股骨粗隆间骨折 股骨近端防旋髓内钉 外侧壁 有限切开技术 

分 类 号：R683.42[医药卫生—骨科学]