InterTAN髓内钉固定老年股骨转子间骨折术中限定与不限定头髓钉滑动的失效风险比较  

Comparison of the failure risks between restricted and unrestricted cephalomedullary nail sliding during InterTAN intramedullary nail fixation for intertrochanteric fractures in the elderly patients

作　　者：王晓伟[1] 杨红梅[1] 高杰[1] 郭艳辉 王晔来 宋占林 孙天胜 张建政[1] 刘智 Wang Xiaowei;Yang Hongmei;Gao Jie;Guo Yanhui;Wang Yelai;Song Zhanlin;Sun Tiansheng;Zhang Jianzheng;Liu Zhi(Department of Orthopaedics,The Seventh Medical Center,General Hospital of the People's Liberation Army,Beijing 100700,China)

机构地区：[1]解放军总医院第七医学中心骨科,北京100700

出　　处：《中华创伤骨科杂志》2024年第9期761-767,共7页Chinese Journal of Orthopaedic Trauma

基　　金：全军后勤科研重点项目(BLJ18J006);北京科技新星计划(Z181100006218031)。

摘　　要：目的比较InterTAN髓内钉固定老年股骨转子间骨折术中限定与不限定头髓钉滑动的术后失效风险。方法回顾性分析2021年1月至2022年12月期间解放军总医院第七医学中心骨科收治的192例老年股骨转子间骨折患者资料。根据术中Inter TAN髓内钉稳定螺钉是否拧紧将患者分为两组:观察组78例,男31例,女47例;年龄(80.2±7.7)岁;骨折AO分型:31-A1型23例,31-A2型55例;术中不拧紧稳定螺钉,不限制头髓钉滑动。对照组114例,男40例,女74例;年龄(81.6±7.8)岁;骨折AO分型:31-A1型42例,31-A2型72例;术中拧紧稳定螺钉,限制头髓钉滑动。比较总体骨折中两组患者之间以及稳定型和不稳定型骨折中两组患者之间的术后1年内固定失效发生率和头髓钉滑移距离。结果两组患者术前一般资料的比较差异均无统计学意义(P>0.05),具有可比性。观察组患者术后1年内固定失效发生率为5.1%(4/78),对照组患者为12.3%(14/114),两组比较差异无统计学意义(P>0.05)。观察组患者的头髓钉滑移距离[7.05(6.00,8.25)mm]显著大于对照组患者[5.65(3.55,7.00)mm],差异有统计学意义(P<0.05)。对于稳定型骨折,观察组与对照组患者的术后1年内固定失效发生率分别为7.1%(2/28)、7.0%(3/43),差异无统计学意义(P>0.05);观察组患者的头髓钉滑移距离[6.00(5.25,7.00)mm]显著大于对照组患者[3.05(2.00,5.00)mm],差异有统计学意义(P<0.05)。对于不稳定型骨折,观察组患者术后1年内固定失效发生率[4.0%(2/50)]显著低于对照组患者[15.5%(11/71)],头髓钉滑移距离[8.00(6.70,10.00)mm]显著大于对照组患者[6.00(4.87,7.57)mm],差异均有统计学意义(P<0.05)。结论稳定螺钉对InterTAN髓内钉固定治疗老年股骨转子间骨折十分重要,拧紧稳定螺钉后,在增加稳定性的同时,也限制了骨折端的加压。对于不稳定型骨折,建议不拧紧稳定螺钉;对于稳定型骨折,是否拧紧稳定螺钉还需进一步观察。Objective To compare the failure risks between restricted and unrestricted cephalomedullary nail sliding during InterTAN intramedullary nail fixation for intertrochanteric fractures in the elderly patients.Methods A retrospective study was conducted to analyze the data of 192 elderly patients with intertrochanteric fracture who had been admitted to Department of Orthopaedics,The Seventh Medical Center,General Hospital of the People's Liberation Army from January 2021 to December 2022.The patients were divided into 2 groups based on whether the set screws were tightened or not during surgery.In the observation group of 78 cases,there were 31 males and 47 females with an age of(80.2±7.7)years,and 23 cases of type 31-A1 and 55 cases of type 31-A2 by the AO classification.Their set screws were not tightened during surgery to allow the cephalomedullary nail sliding.In the control group of 114 cases,there were 40 males and 74 females with an age of(81.6±7.8)years,and 42 cases of type 31-A1 and 72 cases of type 31-A2.Their set screws were tightened during surgery to restrict the cephalomedullary nail sliding.The incidence of postoperative fixation complications and sliding distances of the cephalomedullary nail within 1 year after surgery were compared between the 2 groups in the total fractures and in the stable and unstable fractures as well.Results There was no statistically significant difference in the preoperative general data between the 2 groups of patients,indicating comparability(P>0.05).The incidence of fixation complications within 1 year after surgery was 5.1%(4/78)for the observation group and 12.3%(14/114)for the control group,showing no statistically significant difference between the 2 groups(P>0.05).The sliding distance of the cephalomedullary nail in the observation group[7.05(6.00,8.25)mm]was significantly larger than that in the control group[5.65(3.55,7.00)mm](P<0.05).For stable fractures,the incidence of fixation complications within 1 year after surgery was 7.1%(2/28)for the observation group a

关 键 词：髋骨折 骨折固定术 髓内 骨钉 老年人 内固定失效 

分 类 号：R687.3[医药卫生—骨科学]