加长型InterTAN髓内钉内固定治疗老年股骨转子间骨折的效果  

Effect of extended InterTAN intramedullary nail internal fixation on elderly femoral intertrochanteric fractures

作　　者：陈德高 叶猛 张保[1] CHEN Degao;YE Meng;ZHANG Bao(Orthopedics Department,Anhui Medical University Affiliated Hefei Hospital,Hefei,Anhui 230010,China)

机构地区：[1]安徽医科大学附属合肥医院骨科,安徽合肥230010

出　　处：《中国临床研究》2024年第6期912-916,共5页Chinese Journal of Clinical Research

摘　　要：目的探究加长型InterTAN髓内钉内固定治疗老年股骨转子间骨折的效果及对髋关节功能、并发症发生率的影响。方法纳入合肥市第二人民医院骨科于2019年4月至2022年5月收治的年龄≥60岁的股骨转子间骨折患者138例,根据手术使用髓内钉不同分为短钉组(n=70,标准型InterTAN髓内钉)与长钉组(n=68,加长型InterTAN髓内钉)。比较两组患者围手术期情况(术中出血量、手术时间、下床时间、骨折愈合时间及内固定失效率)、并发症情况,记录术后1 d、3 d、1个月、3个月的视觉模拟量表(VAS)评分。进行6个月的随访,对比两组术前及术后3、6个月Harris髋关节评分。结果长钉组术中出血量[(266.15±52.73)mL vs(243.29±46.13)mL,t=2.71,P=0.01]及手术时间[(84.21±14.54)min vs(72.57±13.08)min,t=4.95,P<0.01]显著高于短钉组,但长钉组下床时间[(9.32±1.74)d vs(11.50±1.67)d,t=7.51,P<0.01]及骨折愈合时间[(3.36±1.24)个月vs(3.85±1.26)个月,t=2.30,P=0.02]显著低于短钉组。两组内固定失效率及术后并发症发生率差异无统计学意义(P>0.05)。两组VAS评分呈现下降趋势,时间效应显著(P<0.05),且长钉组术后1 d、3 d、1个月及3个月的VAS评分显著低于短钉组(P<0.05)。Harris评分组间、时间点及交互效应差异有统计学意义(P<0.05),且长钉组术后3个月、6个月的Harris评分均显著高于短钉组(P<0.05)。结论标准型与加长型InterTAN髓内钉内固定均可有效治疗老年股骨转子间骨折,但加长型InterTAN髓内钉术后愈合更快,术后疼痛感更低,髋关节功能恢复更好。Objective To explore the effect of extended InterTAN intramedullary nail internal fixation in the treatment of elderly femoral intertrochanteric fractures and its influence on hip function and incidence rates of complications.Methods A total of 138 patients with femoral intertrochanteric fractures aged≥60 years admitted to Orthopedics Department of Anhui Medical University Affiliated Hefei Hospital from April 2019 to May 2022 were included.According to the different intramedullary nails during surgery,the patients were divided into short nail group(n=70,standard InterTAN intramedullary nail)and long nail group(n=68,extended InterTAN intramedullary nail).The perioperative conditions(intraoperative blood loss,surgical time,ambulation time,fracture healing time and the rate of internal fixation failure),complications,visual anologue scale(VAS)scores at 1 day,3 days,1 month and 3 months after surgery were compared between the two groups.The patients were followed up for 6 months,and Harris scores were compared between the two groups before surgery and at 3 months and 6 months after surgery.Results Compared with short nail group,intraoperative blood loss was more[(266.15±52.73)mL vs(243.29±46.13)mL,t=2.71,P=0.01]and surgery time was longer[(84.21±14.54)min vs(72.57±13.08)min,t=4.95,P<0.01]in long nail group(P<0.05),but the ambulation time[(9.32±1.74)d vs(11.50±1.67)d,t=7.51,P<0.01]and fracture healing time[(3.36±1.24)months vs(3.85±1.26)months,t=2.30,P=0.02]were significantly shorter(P<0.05).There was no statistically significant difference in internal fixation failure rate and incidence of postoperative complications between two groups(P>0.05).VAS scores of the two groups was gradually decreased,and the difference was significant at different time points within the groups(P<0.05).VAS scores in long nail group at 1 day,3 days,1 month and 3 months after surgery were significantly lower than those in short nail group(P<0.05).The Harris scores revealed a statistical difference from the aspects of between-group,

关 键 词：髓内钉 内固定 股骨转子间骨折 髋关节功能 Harris髋关节评分 加长型InterTAN髓内钉 

分 类 号：R683.4[医药卫生—骨科学]