外侧壁失稳型股骨粗隆间骨折两种髓内固定方式的疗效对比  

Comparison of Clinical Outcomes with Two Different Intramedullary Nailing Devices on the Treatment of Unstable Trochanteric Fractures with Compromised Lateral Wall

作　　者：王瑞鹏 王科英 马续彬 李亮 王志强[4] 韦志坤[1] WANG Ruipeng;WANG Keying;MA Xubin;LI Liang;WANG Zhiqiang;WEI Zhikun(Department of Wound Tissue Repair,The First Hospital of Handan,Handan 056000,Hebei China;Department of Orthopedics,The First Hospital of Handan,Handan 056000,Hebei China;Department of Pediatric Orthopedics,The First Hospital of Handan,Handan 056000,Hebei China;Department of Spinal Bone Oncology,The First Hospital of Handan,Handan 056000,Hebei China)

机构地区：[1]邯郸市第一医院创伤组织修复科,河北邯郸056000 [2]邯郸市第一医院纺织院区骨科 [3]邯郸市第一医院小儿骨科 [4]邯郸市第一医院脊柱骨肿瘤科

出　　处：《中国中医骨伤科杂志》2023年第8期38-42,53,共6页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：邯郸市科学技术研究与发展计划项目(21422083051)。

摘　　要：目的:对比分析Intertan交锁髓内钉与防旋股骨近端髓内钉(PFNA)治疗外侧壁失稳型股骨粗隆间骨折的临床疗效。方法:通过对2018年8月至2021年11月本科收治的老年外侧壁失稳型股骨粗隆间骨折患者186例进行随访并收集临床资料,按照手术内固定方式不同分为Intertan组(88例)和PFNA组(98例),回顾性分析并比较两组患者手术时间、出血量、C臂机透视次数、部分负重时间、骨折愈合时间、尖顶距(Tip-Apex Distance,TAD)、Harris评分及并发症发生情况。结果:所有患者均获得随访,平均随访时间为(16.8±3.4)个月,统计并分析两组患者临床数据结果显示,Intertan组与PFNA组在手术时间、出血量、C臂机透视次数方面差异无统计学意义(P>0.05);Intertan组患者术后部分负重时间平均为(5.8±1.9)d,PFNA组术后部分负重时间平均为(12.1±3.5)d,差异有统计学意义(t=10.137,P=0.008);Intertan组患者骨折愈合时间平均为(12.8±2.9)周,PFNA组骨折愈合时间平均为(16.5±3.4)周,差异有统计学意义(t=7.137,P=0.003);术后即刻、术后1个月及3个月两组患者复查X线片可见尖顶距差异无统计学意义(P>0.05),然而术后6个月及术后12个月Intertan组患者尖顶距均小于PFNA组,差异有统计学意义(P=0.043,0.011);术后3个月及术后12个月Intertan组患者Harris评分分别为(81.3±11.6)分和(89.7±7.2)分,明显高于PFNA组的(68.8±14.5)分和(80.4±6.9)分,差异有统计学意义(P<0.05)。PFNA组有4例头钉切出,3例退钉,1例主钉断裂,3例顽固性髋部或大腿疼痛,1例合并股骨干骨折(12/98,12.24%),Intertan组有1例患者出现头钉切出(1/88,1.13%),差异有统计学意义(P<0.01)。结论:Intertan交锁髓内钉相较于防旋股骨近端髓内钉,在治疗老年股骨粗隆间骨折累及外侧壁者具有稳定性强、有利于早期负重及骨折愈合、促进术后功能恢复及并发症少等优势。Objective:To compare the clinical efficacy of interlocking intramedullary nail(Intertan)and proximal femoral nail antirotation(PFNA)in the treatment of unstable intertrochanteric fractures with compromised lateral wall.Methods:A total of 186 elderly patients diagnosed with unstable intertrochanteric fractures with compromised lateral wall were included in this study,and their clinical data were collected between August 2018 and November 2021.The patients were divided into two groups:the Intertan group(88 cases)and the PFNA group(98 cases),based on the different internal fixation methods.Various parameters including operation time,bleeding volume,C-arm fluoroscopy times,partial weight bearing time,fracture healing time,tip apex distance(TAD),Harris score,and complications were analyzed and compared between the two groups.Results:All patients were followed up for an average of(16.8±3.4)months.The clinical data of the two groups were statistically analyzed.The results showed no significant difference between the Intertan group and the PFNA group in terms of operation time,blood loss,and C-arm fluoroscopy times(P>0.05).However,the mean time of partial weight bearing in the Intertan group was significantly shorter((5.8±1.9)d)compared to the PFNA group((12.1±3.5)d)(t=10.137,P=0.008).The average fracture healing time in the Intertan group was(12.8±2.9)weeks,which was significantly shorter than the average partial weight bearing time in the PFNA group((16.5±3.4)weeks)(t=7.137,P=0.003).The TAD immediately after the operation,at 1 month and 3 months after the operation did not differ significantly between the two groups(P>0.05).However,at 6 months and 12 months after the operation,the TAD in the Intertan group were significantly lower than those in the PFNA group,indicating a better implant positioning(P=0.043,P=0.011).The Harris scores of patients in the Intertan group were significantly higher((81.3±11.6)pionts at 3 months and(89.7±7.2)points at 12 months after the operation)compared to the PFNA group((68.8±14.5)

关 键 词：股骨粗隆间骨折 外侧壁 髓内固定 并发症 

分 类 号：R683.42[医药卫生—骨科学]