加长PFNA是否捆扎固定股骨转子间转子下骨折  

Extended proximal femoral nail anti-rotation with or without cerclages for femoral intertrochanteric and subtrochanteric fractures

作　　者：张立峰[1] 红荣 贾燕飞[1] 郝廷[1] 佟雁翔[1] 李亚光[1] 于成涌[1] 张哲汉 薛飞[1] 王文选[1] 关健 赵国中 冯卫[1] ZHANG Li-feng;HONG Rong;JIA Yan-fei;HAO Ting;TONG Yan-xiang;LI Ya-guang;YU Cheng-yong;ZHANG Zhehan;XUE Fei;WANG Wen-xuan;GUAN Jian;ZHAO Guo-zhong;FENG Wei(Department of Traumatic Orthopaedics,The Second Af-filiated Hospital,Inner Mongolia Medical University,Hohhot 010020,China;Hohhot Center for Disease Control and Prevention,Hohhot 010000,China)

机构地区：[1]内蒙古医科大学第二附属医院创伤外科中心A区,内蒙古呼和浩特010020 [2]呼和浩特市疾控中心,内蒙古呼和浩特010000

出　　处：《中国矫形外科杂志》2024年第10期865-871,共7页Orthopedic Journal of China

基　　金：内蒙古自治区高等学校青年科技英才支持计划项目(编号:NJYT23077);内蒙古自治区卫生健康科技计划项目(编号:202202214);内蒙古医科大学联合项目(编号:YKD2021LH019)。

摘　　要：[目的]探讨加长股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)联合钢丝捆扎治疗股骨转子间转子下骨折的临床效果。[方法]回顾性分析2018年2月—2020年6月本科收治的26例股骨转子间的股骨转子下患者的临床资料。根据医患沟通结果,13例采用单纯加长PFNA固定(未捆扎组),13例采用加长PFNA联合钢丝捆扎固定(捆扎组)。比较两组围手术期、随访及影像结果。[结果]两组患者均顺利完成手术,未捆扎组的切口长度[(8.4±1.7)cm vs(12.3±2.9)cm,P<0.001]、术中透视次数[(49.2±21.5)次vs(62.6±15.3)次,P<0.001]均显著少于捆扎组,但是,捆扎组恢复部分负重时间显著早于未捆扎组[(29.0±7.2)d vs(59.7±14.8)次,P<0.001]。随时间推移,两组患者VAS及Harris评分、髋伸-屈及髋内-外旋ROM显著改善(P<0.05)。捆扎组术后1个月VAS评分[(5.6±0.7)vs(7.3±1.0),P<0.001]、Harris评分[(64.7±8.3)vs(53.1±9.6),P<0.001]、髋伸-屈ROM[(83.2±18.9)°vs(54.7±22.3)°,P<0.001]、髋内-外旋ROM[(46.4±13.7)°vs(35.8±15.1)°,P=0.017]及术后6个月Harris评分[(82.9±7.6)vs(69.5±10.3),P<0.001]均显著优于未捆扎组。影像方面,捆扎组Baumgaertner骨折复位评级显著优于未捆扎组[优/良/差,(11/2/0)vs(3/4/6),P=0.002]。与术前相比,术后1周及末次随访时,两组颈干角、双侧股骨长度差均显著改善(P<0.05),末次随访时,捆扎组颈干角[(125.8±7.7)°vs(117.4±12.3)°,P=0.047]、双侧股骨长度差[(3.0±2.1)mm vs(4.8±3.4)mm,P=0.049]均显著优于未捆扎组。两组骨折愈合的差异无统计学意义(P>0.05)。[结论]加长PFNA联合钢丝捆扎股骨治疗转子间转子下骨折的早期效果优于单纯使用PFNA。[Objective]To investigate the clinical outcomes of extended proximal femoral nail anti-rotation(PFNA)with or without cer⁃clages for femoral intertrochanteric and subtrochanteric fractures.[Methods]A retrospective study was done on 26 patients who received open reduction and internal fixation(ORIF)for femoral intertrochanteric and subtrochanteric fractures in our department from February 2018 to June 2020.According to the surgeon-patient discussion preoperatively,13 patients had the fractures fixed by extended PFNA alone(non-cerclage group),while other 13 patients were fixed by extended PFNA combined with steel wire cerclages(cerclage group).The documents of perioperative period,follow-up and images were compared between the two groups.[Results]All patients in both groups had corresponding surgical procedures performed successfully.Although the non-cerclage group consumed significantly less total incision length[(8.4±1.7)cm vs(12.3±2.9)cm,P<0.001],intraoperative fluoroscopy times[(49.2±21.5)times vs(62.6±15.3)times,P<0.001]than the cerclage group,the cerclage group resumed partial weight bearing activity significantly earlier than the non-cerclage group[(29.0±7.2)days vs(59.7±14.8)days,P<0.001].The VAS and Harris scores,as well as hip extension-flexion range of motion(ROM)and internal-exter⁃nal rotation ROM significantly improved over time in both groups(P<0.05).The cerclage group proved significantly superior to the non-cerclage group in terms of VAS score[(5.6±0.7)vs(7.3±1.0),P<0.001],Harris score[(64.7±8.3)vs(53.1±9.6),P<0.001],hip flexion-exten⁃sion ROM[(83.2±18.9)°vs(54.7±22.3)°,P<0.001],and internal-external rotation ROM[(46.4±13.7)°vs(35.8±15.1)°,P=0.017]1 month postoperatively,as well as Harris score[(82.9±7.6)vs(69.5±10.3),P<0.001]6 months postoperatively.Regarding imaging,the cerclage group proved significantly superior to the non-cerclage group in fracture reduction quality based on Baumgaertner's criteria[excellent/good/poor,(11/2/0)vs(3/4/6),P=0.002].Compared with those preop

关 键 词：股骨转子间转子下骨折 开放复位内固定 髓内钉 捆绑 

分 类 号：R683.42[医药卫生—骨科学]