长、短股骨近端防旋髓内钉治疗A2.3型股骨转子间骨折的疗效比较  

Comparison of effectiveness of long and short proximal femoral nail anti-rotation in treatment of type A2.3 intertrochanteric fracture of femur

作　　者：岳茂明 杨大威[1] YUE Maoming;YANG Dawei(Department of Orthopaedics,the Fourth Affiliated Hospital of Harbin Medical University,Harbin Heilongjiang,150001,P.R.China)

机构地区：[1]哈尔滨医科大学附属第四医院骨科,哈尔滨150001

出　　处：《中国修复重建外科杂志》2024年第6期703-709,共7页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的比较长、短股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)治疗A2.3型股骨转子间骨折(intertrochanteric fracture of femur,IFF)的临床疗效。方法回顾分析2020年1月—2022年12月收治且符合选择标准的54例A2.3型IFF患者临床资料,根据术中使用的PFNA主钉长度分为长钉组(PFNA主钉长度>240 mm,24例)和短钉组(PFNA主钉长度≤240 mm,30例)。两组患者性别、年龄、骨折侧别、身体质量指数、骨折至手术时间等基线资料比较差异均无统计学意义(P>0.05)。记录并比较两组患者手术时间、术中失血量、术中透视次数、术中复位质量评分、骨折愈合情况及并发症发生情况;术后1年采用Harris评分评价患者髋关节功能。根据A2.3型IFF骨折线与小转子的关系,将两组患者细分为Ⅰ型(骨折线延伸至小转子水平)、Ⅱ型(骨折线延伸至小转子下方2 cm以内)、Ⅲ型(骨折线延伸至小转子下方2 cm以外),评价各亚型患者术后稳定性及内固定物松动情况。结果短钉组手术时间、术中失血量、术中透视次数均少于长钉组(P<0.05);两组术中复位质量评分比较差异无统计学意义(P>0.05)。两组患者均获随访,随访时间12~18个月,平均13.5个月。短钉组术后稳定性评分低于长钉组(P<0.05)。术后1年长钉组Harris评分优于短钉组(P<0.05),但两组Harris评分等级比较差异无统计学意义(P>0.05)。长钉组有3例发生并发症(包括1例入钉点偏外导致髋内翻,2例复位丢失均发生内固定物松动),短钉组有7例发生并发症(包括1例入钉点偏外导致髋内翻,6例复位丢失均发生内固定物松动),两组均无股骨前弓破损发生;两组并发症发生率比较差异无统计学意义(P>0.05)。Ⅲ型患者因例数较少未纳入统计;Ⅰ型患者中长、短钉组术后稳定性评分及内固定物松动发生率比较差异无统计学意义(P>0.05);Ⅱ型患者中长钉组术后稳定性评分及内固定物松动发生Objective To compare the effectiveness of long and short proximal femoral nail anti-rotation(PFNA)in the treatment of type A2.3 intertrochanteric fracture of femur(IFF).Methods The clinical data of 54 patients with type A2.3 IFF admitted between January 2020 and December 2022 were retrospectively analyzed.According to the length of PFNA nail used in the operation,they were divided into long nail group(PFNA nail length>240 mm,24 cases)and short nail group(PFNA nail length≤240 mm,30 cases).There was no significant difference in baseline data such as gender,age,fracture side,body mass index,and time from fracture to operation between the two groups(P>0.05).The operation time,intraoperative blood loss,intraoperative fluoroscopy frequency,intraoperative reduction quality score,fracture healing,and complications of the two groups were recorded and compared.Harris score was used to evaluate the hip function of patients at 1 year after operation.According to the relationship between the fracture line of type A2.3 IFF and the lesser trochanter,the two groups of patients were divided into typeⅠ(the fracture line extends to the level of the lesser trochanter),typeⅡ(the fracture line extends to less than 2 cm below the lesser trochanter),and typeⅢ(the fracture line extends to more than 2 cm below the lesser trochanter),and the postoperative stability and internal fixator loosening of each subtype were evaluated.Results The operation time,intraoperative blood loss,and intraoperative fluoroscopy frequency in short nail group were significantly less than those in long nail group(P<0.05).There was no significant difference in the intraoperative reduction quality score between the two groups(P>0.05).Patients in both groups were followed up 12-18 months,with an average of 13.5 months.The postoperative stability score of short nail group was significantly lower than that of long nail group(P<0.05).The Harris score in the long nail group was significantly higher than that in the short nail group at 1 year after operation(P<0

关 键 词：股骨近端防旋髓内钉 股骨转子间骨折 骨折稳定性 

分 类 号：R687.3[医药卫生—骨科学]