亚洲型股骨近端抗旋髓内钉治疗亚洲人群转子间骨折髓内钉突出程度的比较  

Proximal femoral nail antirotation Asian version for treating femoral intertrochanteric fractures:comparison of the protruding degree of intramedullary nails in Asian population

作　　者：王安全 陈昊[1] 华兴一[1] 卢晓林[1] 周剑[1] 崔益亮[1] 李光宇[1] 尹宗生[1] Wang Anquan;Chen Hao;Hua Xingyi;Lu Xiaolin;Zhou Jian;Cui Yiliang;Li Guangyu;Yin Zongsheng(Department of Orthopedics,First Affiliated Hospital of Anhui Medical University,Hefei 230022,Anhui Province,China)

机构地区：[1]安徽医科大学第一附属医院骨科,安徽省合肥市230022

出　　处：《中国组织工程研究》2024年第12期1901-1906,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:因亚洲型股骨近端抗旋髓内钉(PFNA-Ⅱ)设计与亚洲人群的不匹配,治疗股骨转子间骨折时可能会出现股骨转子近端的髓内钉突出,突出长度对手术疗效的影响需要进一步探讨。目的:定量测量PFNA-Ⅱ内固定后髓内钉股骨转子近端突出长度,分析突出长度对PFNA-Ⅱ治疗股骨转子间骨折的疗效是否存在影响。方法:选择68例因股骨转子间骨折在安徽医科大学第一附属医院行PFNA-Ⅱ内固定治疗的患者,于术后6个月内在髋关节X射线前后位片上定量测量股骨大转子近端髓内钉外突值,按照是否存在股骨大转子近端髓内钉突出分为突出组与非突出组。采集患者的性别、身高、骨折类型、使用的髓内钉长度、直径、螺旋刀片在股骨颈的位置及大转子近端髓内钉突出长度等数据,术后6个月时采用髋关节Harris评分及疼痛目测类比评分判断术后疗效,观察PFNA-Ⅱ大转子近端突出对手术疗效是否存在影响。结果与结论:①突出组及非突出组患者性别特征存在明显差异(P=0.001);②按AO/OTA分类,两组患者的骨折类型无明显差异(P=0.289);③两组患者使用的髓内钉直径、长度特征均无明显差异(P=0.067,P=1.000);④患者身高与使用的髓内钉长度无明显相关性(P=0.510),但与突出长度有明显相关性(P=0.034);螺旋刀片位置与突出长度无明显相关性(P=0.968);⑤术后6个月时两组患者髋关节Harris评分差异无显著性意义(P=0.373),但突出组疼痛目测类比评分明显高于非突出组,差异有显著性意义(P=0.000);⑥结果提示PFNA-Ⅱ在治疗亚洲人股骨转子间骨折时,大转子近端经常发生髓内钉突出;当髓内钉伸入大转子近端软组织时,患者主诉大转子近端疼痛,目测类比评分明显高于非突出组;为了更好地适应亚洲人群骨骼特点,建议对PFNA-Ⅱ进行改良,进一步缩短近端钉端,以获得更好的股骨转子间骨折固定效果。BACKGROUND:Due to the mismatch between the design of the proximal femoral nail antirotation Asian version(PFNA-II)and Asian population,extrusion of the proximal femoral intertrochanteric nail may occur in the treatment of femoral intertrochanteric fractures.The influence of the protruding length on the curative effect of the operation needs to be further discussed.OBJECTIVE:To quantitatively measure the protruding length of the proximal trochanter of the femur with intramedullary nail after PFNA-II,and to analyze the effect of protruding length on the efficacy of PFNA-II in the treatment of femoral intertrochanteric fractures.METHODS:Totally 68 patients with femoral intertrochanteric fractures treated with PFNA-II internal fixation in the First Affiliated Hospital of Anhui Medical University were selected.The extramedullary process of the proximal trochanter of the femur was quantitatively measured on the anterior and posterior X-ray films of the hip joint within 6 months after operation.According to the existence of extrusion of the proximal trochanter intramedullary nail,the patients were divided into protruding group and non-protruding group.The data of sex,height,fracture type,length and diameter of the intramedullary nail,the position of screw blade in the femoral neck and protruding length of proximal greater trochanter were collected.The postoperative curative effect was judged by visual analog scale pain score and hip joint Harris score at 6 months after operation.The influence of protruding proximal trochanter of the PFNA-II intramedullary nail on the operative effect was observed.RESULTS AND CONCLUSION:(1)There were significant differences in sexual characteristics between the protruding group and the non-protruding group(P=0.001).(2)According to AO/OTA classification,there were no significant differences in fracture type between the protruding group and the non-protruding group(P=0.289).(3)There was no significant difference in the length and diameter of the intramedullary nail between the two groups(P

关 键 词：股骨转子间骨折 PFNA-Ⅱ 髓内钉突出 内固定 疼痛 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R683.42