PFNA与DHS治疗Seinsheimer V型股骨粗隆下骨折合并肌少症的疗效比较  

Comparative study of PFNA and DHS for the treatment of Seinsheimer V-type of femoral subtrochan-teric fracture with sarcopenia

作　　者：侯传勇 刘新晖 殷建 Hou Chuanyong;Liu Xinhui;Yin Jian(Department of Orthopedics,The Af-filiated Jiangning Hospital with Nanjing Medical University,Nanjing,211100,China)

机构地区：[1]南京医科大学附属江宁医院骨科,南京211100

出　　处：《中华老年骨科与康复电子杂志》2021年第5期277-283,共7页Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)

基　　金：江苏省自然科学基金(SBK2019022658);南京医科大学康达学院科研发展基金(KD2019KYJJZD021);南京市卫健委科技发展资金(YKK19130)。

摘　　要：目的比较股骨近端髓内钉(PFNA)与动力髋螺钉(DHS)治疗Seinsheimer V型股骨粗隆下骨折合并肌少症手术的疗效。方法回顾性分析2016年1月至2018年12月南京医科大学附属江宁医院骨科收治手术的Seinsheimer V型股骨粗隆下骨折合并肌少症患者52例。根据握力及骨骼肌指数(SMI)诊断肌少症。根据手术方式的不同分为PFNA组(28例)和DHS组(24例)。比较两组患者年龄、性别、受伤至手术时间、SMI值、切口长度、手术时间、术中出血量、透视次数,围手术期输血量、下肢完全负重时间、术后3个月和末次随访时的疼痛视觉模拟评分(VAS)和髋关节Harris功能评分,以及术后并发症情况。结果所有患者均获得随访。两组患者年龄、性别、受伤至手术时间和SMI之间差异无统计学意义(t=0.054,P=0.957;c2=0.018,P=0.894;t=0.044,P=0.965;t=-1.298,P=0.200)。PFNA组手术切口长度、出血量和输血量少于DHS组,术中透视次数多于DHS组,差异具有统计学意义(t=-13.016,P=0.000;t=-5.305,P=0.000;t=-2.505,P=0.016;t=9.293,P=0.000),两组手术时间差异无统计学意义(t=0.432,P=0.668)。PFNA组完全负重时间较早、术后3个月VAS评分较低,而Harris评分较高,差异具有统计学意义(t=-3.874,P=0.000;z=-2.009,P=0.045;t=7.139,P=0.000),但末次随访时两组VAS评分和Harris评分差异无统计学意义(z=-1.166,P=0.243;t=0.733,P=0.468)。PFNA组1例发生内固定松动,并发症的发生率为3.57%,DHS组2例发生伤口感染,5例发生内固定松动,并发症的发生率为29.17%,差异具有统计学意义(c2=4.686,P=0.030)。结论PFNA和DHS均是治疗Seinsheimer V型股骨粗隆下骨折合并肌少症的有效方法,但PFNA手术切口短,出血量少,恢复较快,并发症发生率较低,可优先选择。Objective Comparison of the efficacy of proximal femoral nail antirotation(PFNA)and dynamic hip screw(DHS)in the treatment of seinsheimer v-type of subtrochanteric fracture with sarcopenia.Methods From January 2016 to December 2018,52 patients with seinsheimer V-type subtrochanteric frac-ture complicated with sarcopenia were retrospectively analyzed.Sarcopenia was diagnosed by grip strength and skeletal muscle index(SMI).They were divided into PFNA group(28 cases)and DHS group(24 cases).The age,gender,injury to operation time,SMI value,incision length,operation time,intraoperative blood loss,fluoroscopy times,perioperative blood transfusion,lower limb full weight-bearing time,visual analogue scale(VAS)and Harris score at 3 months and the last follow-up were compared between the two groups,as well as the complications.Results All patients were followed up.There was no significant difference in age,gender,injury to operation time and SMI between the two groups(t=0.054,P=0.957,c2=0.018,P=0.894,t=0.044,P=0.965,t=-1.298,P=0.200).The incision length,blood loss and blood transfusion in PFNA group were less than those in DHS group,and the number of fluoroscopy in operation was more than that in DHS group(t=-13.016,P=0.000,t=-5.305,P=0.000,t=-2.505,P=0.016,t=9.293,P=0.000).There was no signifi-cant difference in operation time between the two groups(t=0.432,P=0.668).In PFNA group,the time of complete weight-bearing was earlier,the VAS score was lower 3 months after operation,but the Harris score was higher,the difference was statistically significant(t=-3.874,P=0.000;z=-2.009,P=0.045;t=7.139,P=0.000),but there was no significant difference in VAS score and Harris score between the two groups at the last follow-up(z=-1.166,P=0.243;t=0.733,P=0.468).In PFNA group,1 case had internal fixation loosen-ing,and the incidence of complications was 3.57%.In DHS group,2 cases had wound infection,and 5 cases had internal fixation loosening,and the incidence of complications was 29.17%.The difference was statisti-cally significant(c2=4

关 键 词：髋骨折 肌少症 髓内钉 动力髋螺钉 

分 类 号：R687.3[医药卫生—骨科学]