股骨近端防旋髓内钉与锁定加压钢板治疗老年合并膝骨关节炎股骨转子间骨折的疗效比较  

Comparison of two surgical methods for the treatment of intertrochanteric fractures of the femur in elderly patients with knee osteoarthritis

作　　者：万乾 邬春虎[1] 尹华东[1] 朱晓峰 刘彧 喻友亮 WAN Qian;WU Chun-hu;YIN Hua-dong;ZHU Xiao-feng;LIU Yu;YU You-liang(Department of Orthopaedics,Zhejiang Armed Police Corps Hospital,Hangzhou310012,Zhejiang,China)

机构地区：[1]武警浙江省总队医院骨科,浙江杭州310012

出　　处：《中国骨伤》2024年第10期985-990,共6页China Journal of Orthopaedics and Traumatology

基　　金：浙江省医药卫生科技计划项目(编号:2021432378);浙江省中医药科技计划项目(编号:2021ZB236)。

摘　　要：目的:比较股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)与锁定加压钢板(proximal femoral locking compression plate,PFLCP)治疗老年合并膝骨关节炎股骨转子间骨折的临床疗效。方法:对2015年6月至2021年2月收治的65例老年合并膝骨关节炎股骨转子间骨折患者的临床资料进行回顾性分析,依据手术方法不同分为两组:PFNA组36例,男12例,女24例;年龄61~88(77.0±6.4)岁;左侧17例,右侧19例;改良Evans分型,Ⅱ型3例,Ⅲ型19例,Ⅳ型10例,Ⅴ型4例。PFLCP组29例,男11例,女18例;年龄60~92(78.8±6.5)岁;左侧14例,右侧15例;改良Evans分型,Ⅱ型2例,Ⅲ型18例,Ⅳ型7例,Ⅴ型2例。观察比较两组患者的手术时间、术中出血量、术后卧床时间、术后并发症发生率、骨折愈合时间及术后6个月和1年髋关节Harris评分。结果:65例患者全部获得随访,时间12~24(16.9±3.6)个月。PFNA组和PFLCP组患者手术时间分别为(57.6±6.8)、(77.4±6.5)min;术中出血量分别为(128.3±50.3)、(156.3±22.9)ml;术后卧床时间分别为(4.0±2.5)、(8.1±2.0)d;术后半年髋关节Harris评分分别为(45.3±8.6)、(36.3±7.0)分;两组比较,差异均有统计学意义(P<0.05)。术后并发症发生率分别为19.4%(7/36)、34.5%(10/29),术后1年髋关节Harris评分分别为(60.8±6.7)、(59.0±8.1)分;两组比较,差异均无统计学意义(P>0.05)。结论:与PFLCP相比,PFNA治疗老年合并膝骨关节炎股骨转子间骨折手术时间短,术中出血少,术后卧床时间短、短期髋关节功能恢复更好,在患肢膝关节可耐受牵引时,可作为优先选择。Objective To explore the difference in the effectiveness between proximal femoral nail anti-rotation(PFNA)and proximal femoral locking compression plate(PFLCP)of intertrochanteric fracture in the elderly patients combined with knee osteoarthritis.Methods The clinical data of 65 intertrochanteric femoral fractures combined with knee osteoarthritis between June 2015 and February 2021 were retrospectively analyze.They were divided into two groups according to the different surgical methods.PFNA group was composed of 36 patients,12 males and 24 females,aged from 61to 88 years old with an average of(77.0±6.4)years old.There were 17 cases of left injury and 19 cases of right injury.According to modified Evans classification,there were 3 cases of typeⅡ,19 cases of typeⅢ,10 cases of typeⅣ,and 4 cases of typeⅤ.PFLCP group was composed of 29 patients,11 males and 18 females,aged from 60 to 92 years old with an average of(78.8±6.5)years old.There were 14 cases of left injury and 15 cases of right injury.According to modified Evans classification,there were 2 cases of typeⅡ,18 cases of typeⅢ,7 cases of typeⅣ,and 2 cases of typeⅤ.Comparison of operation time,intraoperation blood loss,postoperative bed time,incidence of postoperative complications,Harris score at 6 months and 1 year postoperation.Results All 65 patients were followed up ranging from 12 to 24 months with an average of(16.9±3.6)months.In the PFNA and PFLCP groups,the operation time was respectively(57.6±6.8)min and(77.4±6.5)min,the intraoperative blood loss was(128.3±50.3)ml and(156.3±23.9)ml,postoperative bed time was(4.0±2.5)days and(8.1±2.0)days,Harris score at 6 months postoperative was(45.3±8.6)points and(36.3±7.0)points.There were significant differences between two groups(P<0.05).Incidence of postoperative complications was 19.4%(7/36)and 34.5%(10/29),Harris score at 1 year postoperative was(60.8±6.7)points and(59.0±8.1)points.There was no significant difference between the two groups(P>0.05).Conclusion Compared with PFLCP,PFN

关 键 词：髋部骨折 膝骨关节炎 股骨近端防旋髓内钉 锁定加压钢板 内固定 

分 类 号：R683.42[医药卫生—骨科学]