PFNA联合锁定钢板治疗合并外侧壁骨折的老年粗隆间骨折的临床疗效  

Clinical effects of PFNA plus locking plates in the treatment of intertrochanteric femoral fractures combined with lateral wall fractures in the elderly

作　　者：田志[1] 陈佳[1] 邱长茂 李文毅[1] 高尚聚[1] 张亚洲 赵明明 Tian Zhi;Chen Jia;Qiu Changmao;Li Wenyi;Gao Shangju;Zhang Yazhou;Zhao Mingming(Department of Orthopedics,Hebei General Hospital,Shijiazhuang 050057,China)

机构地区：[1]河北省人民医院骨科,石家庄050057

出　　处：《创伤外科杂志》2022年第12期919-923,共5页Journal of Traumatic Surgery

基　　金：河北省卫健委项目(20190321)。

摘　　要：目的研究防旋型股骨近端髓内钉(proximal femoral nail antirotation,PFNA)联合锁定钢板治疗合并外侧壁骨折的老年粗隆间骨折的临床效果。方法采用回顾性研究方式,收集2019年1月—2020年12月期间河北省人民医院骨科收治的48例合并股骨外侧壁骨折的老年粗隆间骨折患者的临床资料,男性21例,女性27例;年龄65~98岁,平均79.6岁。按照当时所采取的手术方式不同,将患者分为试验组(n=24)和对照组(n=24)。试验组采用PFNA联合使用锁定钢板对外侧壁进行重建,对照组仅使用PFNA进行粗隆间骨折的固定,未重建外侧壁。比较两组手术时间、透视次数、术中出血量、下床活动时间、负重锻炼时间、骨折愈合时间、末次随访髋关节功能(Harris评分)及并发症发生等。结果48例患者均获得随访,时间9~18个月,平均12.6个月。与对照组相比,试验组手术时间[(81.25±6.90)min vs.(72.21±6.72)min]、术中出血量[(97.54±6.99)mL vs.(70.63±9.87)mL]、术中透视次数[(49.67±6.23)次vs.(38.33±8.32)次]均有所增加(P<0.05);试验组在下床活动时间[(8.83±3.13)d vs.(11.50±1.72)d]、骨折愈合时间[(13.71±3.98)周vs.(16.29±3.67)周]、负重锻炼时间[(11.42±3.35)周vs.(14.33±2.76)周]和末次随访Harris评分[(88.46±4.23)分vs.(81.21±6.31)分]方面均具有明显优势(P<0.05);在术后并发症方面,试验组发生率为12.5%,明显低于对照组的37.5%(P<0.05)。结论对于合并外侧壁骨折的老年粗隆间骨折,重建外侧壁可以获得更好的治疗效果,可以提高骨折复位质量,有效减少术后并发症,促进骨折愈合和髋关节功能的恢复。Objective To study the clinical effect of proximal femoral nail antirotation(PFNA)+locking plate in the treatment of intertrochanteric fractures combined with lateral wall fractures in the elderly.Methods A retrospective study was conducted to collect the clinical data of 48 elderly patients with intertrochanteric fractures associated with lateral femoral wall fractures,who were admitted to the department of orthopedics of Hebei General Hospital from Jan.2019 to Dec.2020.There were 21 males and 27 females;aged 65-98 years,mean 79.6 years.Based on the different surgical methods applied,patients were divided into experimental group(locking plates were used to reconstruct the lateral wall,n=24)and control group(only PFNA fixation of the intertrochanteric fractures was conducted,without reconstruction of the lateral wall using locking plates,n=24).The operation time,fluoroscopy times,blood loss,time of out-of-bed activities,time to start weight-bearing exercises,fracture healing time,hip joint function(Harris score)and complications at the last follow-up were compared between the two groups.Results All the 48 patients were followed up for 9-18 months(mean 12.6 months).Compared with the control group,the experimental group had a longer operation time[(81.25±6.90)min vs.(72.21±6.72)min],more intraoperative blood loss[(97.54±6.99)mL vs.(70.63±9.87)mL]and more times of intraoperative fluoroscopy[49.67±6.23 vs.38.33±8.32](all P<0.05).But the experimental group showed great superiority in terms of quicker out-of-bed activities[(8.83±3.13)d vs.(11.50±1.72)d],fracture healing[(13.71±3.98)weeks vs.(16.29±3.67)weeks]and weight bearing exercises[(11.42±3.35)weeks vs.(14.33±2.76)weeks],as well as better Harris score at last follow-up(88.46±4.23 vs.81.21±6.31)(all P<0.05).As for postoperative complications,the incidence in experimental group was 12.5%,significantly lower than that in control group(37.5%,P<0.05).Conclusion For the elderly patients with intertrochanteric fractures and lateral wall fractures,to reconst

关 键 词：股骨粗隆间骨折 内固定 髓内钉 功能重建 

分 类 号：R687.3[医药卫生—骨科学]