改良“糖果包扎”钢丝内固定联合股骨近端防旋髓内钉内固定治疗老年A2型股骨转子间骨折的临床研究  

A clinical study of modified candy-package wire internal fixation combined with proximal femoral nail antirotation internal fixation for treatment of type A2 femoral intertrochanteric fractures in the aged

作　　者：张威[1] 赵士君[1] 李翔[1] 燕冰[1] ZHANG Wei;ZHAO Shijun;LI Xiang;YAN Bing(Zhengzhou Orthopedics Hospital,Zhengzhou 450052,Henan,China)

机构地区：[1]郑州市骨科医院,河南郑州450052

出　　处：《中医正骨》2021年第10期23-28,共6页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:探讨改良“糖果包扎”钢丝内固定联合股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定治疗老年A2型股骨转子间骨折的临床疗效和安全性。方法:回顾性分析32例老年A2型股骨转子间骨折患者的病例资料,将采用改良“糖果包扎”钢丝内固定联合PFNA内固定治疗的患者纳入联合治疗组(19例),将仅采用PFNA内固定治疗的患者纳入单纯PFNA内固定治疗组(13例)。比较2组患者的手术时间、术中出血量、骨折愈合时间、Harris髋关节评分及并发症发生率。结果:①一般指标。联合治疗组患者手术时间长于单纯PFNA内固定治疗组[(67.3±16.8)min,(50.4±15.2)min,t=0.332,P=0.035]、术中出血量多于单纯PFNA内固定治疗组[(167±46)mL,(122±23)mL,t=0.447,P=0.015]、骨折愈合时间短于单纯PFNA内固定治疗组[(11.7±3.3)周,(13.9±2.6)周,t=0.612,P=0.027]。②Harris髋关节评分。术后12个月,联合治疗组患者Harris髋关节评分高于单纯PFNA内固定治疗组[(94.5±3.6)分,(85.4±6.8)分,t=0.022,P=0.015]。③并发症发生率。联合治疗组均未发生血管神经损伤、切口感染、内固定失效、髋内翻畸形、下肢短缩畸形等并发症;单纯PFNA内固定治疗组,术后2个月发生髋内翻畸形1例、螺旋刀片切出股骨头1例。2组患者并发症发生率比较,差异无统计学意义(χ^(2)=3.118,P=0.077)。结论:采用改良“糖果包扎”钢丝内固定联合PFNA内固定治疗老年A2型股骨转子间骨折,与单纯PFNA内固定相比,手术时间长、术中出血量多,但骨折愈合快、更有利于髋关节功能恢复,二者安全性相当。Objective:To explore the clinical curative effects and safety of modified candy-package wire internal fixation combined with proximal femoral nail antirotation(PFNA)internal fixation for treatment of type A2 femoral intertrochanteric fractures in the aged.Methods:The medical records of 32 aged patients with type A2 femoral intertrochanteric fractures were analyzed retrospectively.Nineteen patients were treated with modified candy-package wire internal fixation and PFNA internal fixation(combination treatment group),while the others with PFNA internal fixation alone(PFNA internal fixation group).The operative time,intraoperative blood loss,fracture healing time,Harris hip scores and complication incidence were compared between the 2 groups.Results:The operative time was longer,the intraoperative blood loss was more,and the fracture healing time was shorter in combination treatment group compared to PFNA internal fixation group(67.3±16.8 vs 50.4±15.2 minutes,t=0.332,P=0.035;167±46 vs 122±23 mL,t=0.447,P=0.015;11.7±3.3 vs 13.9±2.6 weeks,t=0.612,P=0.027).The Harris hip scores were higher in combination treatment group compared to PFNA internal fixation group at 12 months after the surgery(94.5±3.6 vs 85.4±6.8 points,t=0.022,P=0.015).No complications such as neurovascular injury,incision infection,failed internal fixation,coxa vara deformity and lower limb shortening deformity were found in combination treatment group;while the coxa vara deformity(1 case)and spiral blade protrusion from femoral head(1 case)were found in PFNA internal fixation group at 2 months after the surgery.There was no statistical difference in complication incidences between the 2 groups(χ^(2)=3.118,P=0.077).Conclusion:The combination therapy of modified candy-package wire internal fixation and PFNA internal fixation has the disadvantages as longer operative time and more intraoperative blood loss,but advantages as faster fracture healing and better recovery of hip function compared to monotherapy of PFNA internal fixation in treatment

关 键 词：髋骨折 转子间骨折 股骨 小转子 老年人 骨折固定术 内 “糖果包扎” 骨固定钢丝 股骨近端防旋髓内钉 临床试验 

分 类 号：R687.3[医药卫生—骨科学]