干骺端扩髓与不扩髓股骨近端防旋髓内钉治疗老年股骨转子间骨折的早期疗效比较  

Comparative efficacy of proximal femoral nail antirotation with metaphyseal expansion or non-expansion in the early treatment of femoral intertrochanteric fracture of the elderly

作　　者：张金星[1] 海啸 裴少新 徐永申[2] Zhang Jinxing;Hai Xiao;Pei Shaoxin;Xu Yongshen(Trauma Department of Zhengzhou Orthopedic Hospital,Zhengzhou 450052,China;Department of Orthopedicsand Arthrology,Second Affiliated Hospital of Henan University of Science and Technology,Luoyang 471000,China)

机构地区：[1]郑州市骨科医院创伤外科,郑州450052 [2]河南科技大学第二附属医院骨关节科,洛阳471000

出　　处：《中华创伤杂志》2024年第10期910-918,共9页Chinese Journal of Trauma

基　　金：2020年度河南省医学科技攻关计划联合共建项目(LHGJ20200597)。

摘　　要：目的比较干骺端扩髓与不扩髓股骨近端防旋髓内钉(PFNA)治疗老年股骨转子间骨折的疗效。方法采用回顾性队列研究分析2019年5月至2023年5月郑州市骨科医院收治的349例老年股骨转子间骨折患者的临床资料,其中男168例,女181例;年龄60~84岁[(73.5±8.6)岁]。骨折AO分型:A1型108例,A2型164例,A3型77例。168例行近端干骺端扩髓PFNA治疗(扩髓组),181例行近端干骺端不扩髓PFNA治疗(未扩髓组)。比较两组手术时间、术中失血量、隐性失血量、术后引流量、总失血量、术中输血率、住院时间;术前、术后2周、术后6周视觉模拟评分(VAS);术前、术后即刻、术后6个月颈干角、尖顶距;术后1、3、6个月Harris髋关节功能评分;下地负重时间、骨折愈合时间及术后并发症发生率。结果患者均获随访6~10个月[(7.8±1.2)个月]。扩髓组手术时间为(69.6±12.4)min,长于未扩髓组的(65.3±11.5)min(P<0.01);术中失血量、隐性失血量、术后引流量、总失血量分别为(124.8±16.9)ml、(684.1±95.3)ml、(123.9±25.1)ml、(932.8±125.4)ml,均多于未扩髓组的(96.3±12.6)ml、(623.4±87.4)ml、(110.6±29.7)ml、(830.3±112.6)ml(P<0.01);术中输血率为50.0%(84/168),高于未扩髓组的38.1%(69/181)(P<0.05)。两组住院时间差异无统计学意义(P>0.05)。两组术前、术后2周、术后6周VAS比较,差异均无统计学意义(P>0.05)。两组术后2、6周VAS均较术前降低,且术后6周VAS均较术后2周降低(P<0.05)。两组术前、术后即刻、术后6个月颈干角、尖顶距比较,差异均无统计学意义(P>0.05)。两组术后即刻、术后6个月颈干角均较术前减小,尖顶距均增大,且术后6个月颈干角均较术后即刻减小,尖顶距均增大(P<0.05)。两组术后1、3、6个月Harris髋关节功能评分比较,差异均无统计学意义(P>0.05)。两组术后3、6个月Harris髋关节功能评分均较术后1个月升高,且术后6个月Harris髋关节功能评分均较术后3个�Objective To compare the efficacy of proximal femoral nail antirotation(PFNA)with metaphyseal expansion or non-expansion in the treatment of femoral intertrochanteric fracture in the elderly.Methods A retrospective cohort study was conducted to analyze the clinical data of 349 elderly patients with femoral intertrochanteric fracture,comprising 168 males and 181 females,aged 60-84 years[(73.5±8.6)years].According to AO fracture classification,108 patients were classified as type A1,164 type A2,and 77 type A3.Of them,168 patients received PFNA with metaphyseal expansion(expansion group),while 181 received PFNA with metaphyseal non-expansion(non-expansion group).The operation time,intraoperative blood loss,recessive blood loss,postoperative drainage volume,total blood loss,intraoperative blood transfusion rate and length of hospital stay were compared between the two groups.Visual analogue scale(VAS)scores preoperatively,at 2 and 6 weeks postoperatively of the two groups were detected.The neck-shaft angle and tip-apex distance were measured preoperatively,immediately after surgery,and at 6 months postoperatively.Harris hip score was evaluated at 1,3,and 6 months postoperatively.Additionally,time to weight-bearing ambulation,fracture healing time,and postoperative complication rate were compared between the two groups.Results All the patients were followed up for 6-10 months[(7.8±1.2)months].The operation time for the expansion group was(69.6±12.4)minutes,significantly longer than(65.3±11.5)minutes of the non-expansion group(P<0.01).Intraoperative blood loss,recessive blood loss,postoperative drainage volume and total blood loss were(124.8±16.9)ml,(684.1±95.3)ml,(123.9±25.1)ml and(932.8±125.4)ml respectively,which were more than those of the non-expansion group[(96.3±12.6)ml,(623.4±87.4)ml,(110.6±29.7)ml,and(830.3±112.6)ml](P<0.01).The intraoperative blood transfusion rate was 50.0%(84/168),higher than 38.1%(69/181)of the non-expansion group(P<0.05).There was no significant difference in the length of hos

关 键 词：股骨骨折 骨质疏松 老年人 骨折固定术 髓内 

分 类 号：R687.3[医药卫生—骨科学]