老年股骨粗隆间骨折两种髓内固定比较  

Comparison of two kinds of intramedullary fixation for intertrochanteric fracture of femur in the elderly

作　　者：秦颖达 李衡[1] QIN Ying-da;LI Heng(Emergency Center of Trauma,The Third Hospital,Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第三医院创伤急救中心,河北石家庄市050051

出　　处：《中国矫形外科杂志》2021年第22期2032-2037,共6页Orthopedic Journal of China

摘　　要：[目的]比较股骨近端联合加压交锁髓内钉系统(InterTan)与股骨近端防旋髓内钉(proximal femoral nail antirota-tion,PFNA)治疗老年股骨粗隆间骨折的临床疗效。[方法]回顾性研究2019年1月-2020年6月于本院治疗的老年股骨粗隆间骨折107例患者的临床资料。其中,46例采用InterTan内固定(InterTan组),61例采用PFNA内固定(PFNA组)。比较两组围手术期、随访与影像等资料。[结果]两组患者均顺利完成手术,InterTan组手术时间、切口总长度、术中失血量及术中透视次数显著差于PFNA组(P<0.05)。两组患者术后平均随访时间为(13.84±1.59)个月。InterTan组患者恢复完全负重活动时间显著早于PFNA组(P<0.05)。与术后3个月相比,末次随访时两组VAS评分显著减少(P<0.05),而髋伸-屈ROM和Harris评分显著增加(P<0.05)。术后3个月时InterTan组的髋伸屈ROM及Harris评分均显著优于PFNA组(P<0.05)。影像方面,术后影像显示两组的骨折复位质量差异无统计学意义(P>0.05)。InterTan组骨折愈合时间显著早于PFNA组(P<0.05)。InterTan组在术后3个月及末次随访中出现髋内翻畸形、股骨颈短缩畸形和尖顶距缩小的概率均显著低于PFNA组(P<0.05)。[结论]虽然PFNA在手术操作更为便利,但是InterTan术后固定更为稳定,有利于骨折愈合。[Objective]To compare the clinical efficacy of the interTan nail versus proximal femoral nail antirotation(PFNA)for femoral intertrochanteric fractures in the elderly.[Methods]A retrospective study was conducted on 107 elderly patients who received surgical treatment for femoral intertrochanteric fracture in our hospital from January 2019 to June 2020.Among them,46 patients had fractures fixed by the interTan nail,while the remaining 61 patients were treated with PFNA.The documents regarding to perioperative period,follow-up and radiographs were compared between the two groups.[Results]All the patients in both groups had operation performed smoothly.The interTan group was significantly inferior to the PFNA group in terms of operation time,total incision length,intraoperative blood loss and intraoperative fluoroscopy(P<0.05).All patients of the two groups were followed up for(13.84±1.59)months on average postoperative-ly.The interTan group resumed full weight bearing activity significantly earlier than the PFNA group(P<0.05).The VAS score significantly decreased,whereas the hip extension-flexion range of motion(ROM)and Harris score significantly increased in both groups at the latest follow-up compared with those at 3 months postoperatively(P<0.05).The interTan group proved significantly superior to the PFNA group in terms of ROM and Harris score at 3 months postoperatively(P<0.05).With respect of radiographic evaluation,although there was no a statistically significant difference in fracture reduction quality revealed by postoperative images,the interTan group got bony healing significantly earlier than the PFNA group(P<0.05),additionally the former had significantly lower ratio of adverse changes,including coxa vara,shortening of femoral neck,and loss of tip-apex distance(TAD),than the latter at 3 months postoperatively and the latest follow-up(P<0.05).[Conclusions]The PFNA is more conducive in surgical manipulation,whereas the interTan does provide more fixation stability,which is favor of fracture healing.

关 键 词：股骨粗隆间骨折 骨折复位内固定 髋部联合加压交锁髓内钉 股骨近端防旋髓内钉 

分 类 号：R683.42[医药卫生—骨科学]