股骨角稳定带锁髓内钉与近端防旋髓内钉治疗顺转子间骨折的疗效比较  

Comparison of the efficacy of femoral stable interlocking intramedullary nail and proximal femoral nail anti-rotation in the treatment of anterograde intertrochanteric fractures

作　　者：郝宝喜 贾鹏 王永清[1] 杨志强[1] 任亮 高卓 赵志辉[1] 徐占敏 Hao Baoxi;Jia Peng;Wang Yongqing;Yang Zhiqiang;Ren Liang;Gao Zhuo;Zhao Zhihui;Xu Zhanmin(Department of Orthopaedics,the Fourth Central Hospital Affiliated to Nankai University,Tianjin 300140,China;Department of Orthopaedics,Characteristic Medical Center of Chinese People's Armed Police Force,Tianjin 300162,China;Affiliated Hospital of Shaanxi University of Chinese Medicine,Xianyang 712000,China)

机构地区：[1]南开大学附属第四中心医院骨科,天津300140 [2]中国人民武装部队特色医学中心骨科,天津300162 [3]陕西中医药大学附属医院骨伤医院关节病区,咸阳712000

出　　处：《中华骨科杂志》2022年第18期1212-1219,共8页Chinese Journal of Orthopaedics

摘　　要：目的比较股骨角稳定带锁髓内钉(femoral stable interlocking intramedullary nail,FSIIN)和股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)治疗股骨顺转子间骨折的疗效。方法回顾性分析2015年6月至2020年12月治疗股骨顺转子间骨折患者68例,其中31例采用FSIIN远端不安装锁钉固定(FSIIN组)、37例采用PFNA固定(PFNA组)。FSIIN组男18例、女13例;年龄(62.4±8.6)岁(范围47~84岁);左侧15例、右侧16例;AO/OTA分型:A1型11例、A2型20例。PFNA组男17例、女20例;年龄(62.9±7.1)岁(范围48~78岁);左侧18例、右侧19例;AO/OTA分型:A1型16例、A2型21例。比较两种固定方式的骨折固定时间、切口总长度、术中出血量、骨折愈合时间、末次随访时视觉模拟评分(visual analogue scale,VAS)和Harris评分。结果两组均获得随访,随访时间FSIIN组为(15.3±3.9)个月、PFNA组为(15.7±3.9)个月,差异无统计学意义(t=0.42,P=0.675)。FSIIN组骨折固定时间(26.6±11.5)min、切口总长度(7.6±1.8)cm、术中出血量(107.6±42.8)ml、骨折愈合时间(10.1±1.3)周;PFNA组分别为(40.3±10.8)min、(12.2±1.8)cm、(209.4±52.0)ml、(16.3±1.6)周。FSIIN组的骨折固定时间(t=3.46,P<0.001)、切口总长度(t=2.39,P=0.020)、术中出血量(t=3.16,P<0.001)、骨折愈合时间(t=2.80,P<0.001)均较PFNA组少,差异有统计学意义。FSIIN组VAS评分为(1.4±0.5)分,PFNA组为(1.6±0.6)分,差异无统计学意义(t=0.68,P=0.503)。末次随访时,FSIIN组Harris评分为(84.5±2.2)分,PFNA组为(83.3±2.5)分,差异无统计学意义(t=0.63,P=0.530)。FSIIN组29例患者表示对手术非常满意、2例为满意,满意率为100%;PFNA组30例患者表示对手术非常满意、7例为满意,满意率为100%。结论与PFNA相比,FSIIN固定股骨顺转子间骨折手术操作更微创、简单、省时、出血少、风险小,骨折可获得快速愈合,但两者术后近期疗效相似。Objective To evaluate the effect of femoral stable interlocking intramedullary nail(FSIIN)and proximal femoral nail anti-rotation(PFNA)in the treatment of anterograde intertrochanteric fractures.Methods From June 2015 to December 2020,68 cases with surgically treated of femoral intertrochanteric fractures were included.Among them,there were 37 cases(17 males and 20 females)in proximal femoral nail antirotation(PFNA)group,and the age ranged from 48 to 78 years(62.9±7.1 years);18 cases were on the left and 19 cases on the right;AO/OTA classification:16 cases of A1 type and 21 cases of A2 type.And there were 31 cases(18 males and 13 females)in FSIIN group without distal locking,the age ranged from 47 to 84 years(62.4±8.6 years);15 cases were on the left and 16 cases on the right;AO/OTA classification:11 cases of A1 type and 20 cases of A2 type.Fracture fixation time,incision length and number,intraoperative blood loss,fracture healing time,visual analogue scale(VAS)and Harris scores at the last follow-up were compared between the two fixation methods.Results Both groups were followed up,and the follow-up time was 15.3±3.9 months in the FSIIN group and 15.7±3.9 months in the PFNA group,and the difference was not statistically significant(t=0.42,P=0.675).In FSIIN group,the fracture fixation time was 26.6±11.5 min,the total incision length was 7.6±1.8 cm,the intraoperative blood loss was 107.6±42.8 ml and the fracture healing time was 10.1±1.3 weeks.In PFNA group,the fracture fixation time was 40.3±10.8 min,the total incision length was 12.2±1.8 cm,the intraoperative blood loss was 209.4±52.0 ml and the fracture healing time was 16.3±1.6 weeks.In FSIIN group,the fracture fixation time(t=3.46,P<0.001),total incision length(t=2.39,P=0.020),intraoperative blood loss(t=3.16,P<0.001),fracture healing time(t=2.80,P<0.001)were all less than those in PFNA group,and the difference was statistically significant.The VAS score of FSIIN group was 1.4±0.5 points,and that of PFNA group was 1.6±0.6 points,and the differe

关 键 词：股骨骨折 骨折固定术 髓内 内固定器 

分 类 号：R687.3[医药卫生—骨科学]