股骨近端仿生髓内钉治疗老年股骨转子间骨折的疗效研究  

Effectiveness of proximal femur bionic nail for intertrochanteric fracture in the elderly

作　　者：杨冬松[1] 王琼[1] 栾中豪 凌建生 陈鹏[1] 陈许冬 远东涛[1] 甄相周[1] 王军强[3] YANG Dongsong;WANG Qiong;LUAN Zhonghao;LING Jiansheng;CHEN Peng;CHEN Xudong;YUAN Dongtao;ZHEN Xiangzhou;WANG Junqiang(Department of Orthopedics,the Second Affiliated Hospital of Luohe Medical College,Luohe Henan,462300,P.R.China;Department of Information,the Second Affiliated Hospital of Luohe Medical College,Luohe Henan,462300,P.R.China;Department of Orthopaedic Trauma,Beijing Jishuitan Hospital,Beijing,100035,P.R.China)

机构地区：[1]漯河医学高等专科学校第二附属医院骨科,河南漯河462300 [2]漯河医学高等专科学校第二附属医院信息科,河南漯河462300 [3]北京积水潭医院创伤骨科,北京100035

出　　处：《中国修复重建外科杂志》2023年第10期1198-1204,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：河南省重点研发与推广专项项目(212102310722);河南省医学科技攻关项目(LHGJ20200885);漯河医学高等专科学校科技创新项目(2022KJZD29)。

摘　　要：目的 通过与股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)比较,探讨股骨近端仿生髓内钉(proximal femur bionic nail,PFBN)治疗老年股骨转子间骨折的疗效。方法 回顾分析2020年1月—2022年12月收治且符合选择标准的48例老年股骨转子间骨折患者临床资料。其中,24例骨折复位后采用PFBN内固定(PFBN组),24例采用PFNA内固定(PFNA组)。两组患者年龄、性别、致伤原因、骨折侧别及分型、受伤至手术时间以及术前活动能力评分、美国麻醉师协会(ASA)评分、老年痴呆程度评分、生活自理能力评分、骨质疏松程度(T值)、合并内科疾病情况等基线资料比较,差异均无统计学意义(P>0.05)。记录并比较两组手术时间、术中出血量、术中输血例数及输血量、住院时间、并发症发生情况,术后患者下地站立时间、疼痛视觉模拟评分(VAS)、行走能力评分、活动能力评分、生活自理能力评分;同时,影像学复查骨折复位质量以及术后稳定性评分,骨折愈合情况并记录愈合时间。结果 两组手术均顺利完成且患者术后均获随访,随访时间6~15个月,PFBN组平均9.8个月、PFNA组9.6个月。PFBN组手术时间长于PFNA组(P<0.05),但两组术中出血量、输血例数、输血量以及术后住院时间、活动能力评分变化值、生活自理能力评分变化值比较,差异均无统计学意义(P>0.05)。PFBN组患者术后下地站立时间较PFNA组缩短,术后VAS评分、行走能力评分均优于PFNA组,差异有统计学意义(P<0.05)。影像学复查示两组骨折复位评分以及术后稳定性评分差异均无统计学意义(P>0.05),骨折均愈合且愈合时间差异亦无统计学意义(P>0.05)。PFBN组并发症发生率(16.7%,4/24)低于PFNA组(45.8%,11/24),差异有统计学意义(P<0.05)。结论 与PFNA相比,老年股骨转子间骨折复位后采用PFBN内固定能有效缓解疼痛,缩短术后卧床时间,降低并发症发生风险,有利于患者�Objective To evaluate effectiveness of proximal femur bionic nail(PFBN)in treatment of intertrochanteric fractures in the elderly compared to the proximal femoral nail antirotation(PFNA).Methods A retrospective analysis was made on 48 geriatric patients with intertrochanteric fractures,who met the selection criteria and were admitted between January 2020 and December 2022.Among them,24 cases were treated with PFBN fixation after fracture reduction(PFBN group),and 24 cases were treated with PFNA fixation(PFNA group).There was no significant difference in baseline data such as age,gender,cause of injury,side and type of fracture,time from injury to operation,and preoperative mobility score,American Society of Anesthesiologists(ASA)score,Alzheimer’s disease degree scoring,selfcare ability score,osteoporosis degree(T value),and combined medical diseases between the two groups(P>0.05).The operation time,intraoperative blood loss,number of blood transfusions,transfusion volume,length of hospital stay,occurrence of complications,weight-bearing time after operation,and postoperative visual analogue scale(VAS)score,walking ability score,mobility score,self-care ability score were recorded and compared between the two groups.And the radiographic assessment of fracture reduction quality and postoperative stability,and fracture healing time were recorded.Results The operations in both groups were successfully completed.All patients were followed up 6-15 months with an average time of 9.8 months in PFBN group and 9.6 months in PFNA group.The operation time was significantly longer in PFBN group than in PFNA group(P<0.05),but there was no significant difference in intraoperative blood loss,number of blood transfusions,transfusion volume,length of hospital stay,change in activity ability score,and change in self-care ability score between the two groups(P>0.05).The weight-bearing time after operation was significantly shorter in PFBN group than in PFNA group(P<0.05),and the postoperative VAS score and walking ability score we

关 键 词：股骨转子间骨折 股骨近端防旋髓内钉 股骨近端仿生髓内钉 内固定 老年人 

分 类 号：R687.3[医药卫生—骨科学]