双平面固定联合植骨治疗重度骨质疏松性复杂股骨转子间骨折的疗效  

Efficacy of biplanar fixation combined with bone grafting in the treatment of critically complicated osteoporotic intertrochanteric femoral fracture

作　　者：曹发奇 谢旭东 周武[1] 米博斌 胡益强 薛航 刘梦非 张英泽[2] 刘国辉[1] Cao Faqi;Xie Xudong;Zhou Wu;Mi Bobin;Hu Yiqiang;Xue Hang;Liu Mengfei;Zhang Yingze;Liu Guohui(Department of Orthopedic Surgery,Union Hospital,Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430022,China;Department of Orthopedic Surgery,Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]华中科技大学同济医学院附属协和医院骨科,武汉430022 [2]河北医科大学第三医院骨科,石家庄050051

出　　处：《中华创伤杂志》2025年第1期51-57,共7页Chinese Journal of Trauma

基　　金：国家重点研发计划(2018YFC2001502)。

摘　　要：目的比较双平面固定联合植骨与股骨近端防旋髓内钉(PFNA)内固定治疗重度骨质疏松性复杂股骨转子间骨折的疗效。方法采用回顾性队列研究分析2020年1月至2022年12月华中科技大学同济医学院附属协和医院收治的28例重度骨质疏松性复杂股骨转子间骨折患者的临床资料,其中男3例,女25例;年龄70~91岁[(79.4±6.3)岁]。骨密度T值-2.5~-4.1 SD[(-3.3±0.6)SD]。AO分型A2.2~A3.3型,均合并股骨大转子外侧壁骨折。16例行双平面固定联合植骨治疗(双平面固定组),12例行PFNA内固定治疗(PFNA组)。患者术后均接受抗骨质疏松治疗。比较2组手术时长、术中失血量、术后3 d血红蛋白水平、下地负重时间;术后1、3、6个月及末次随访时视觉模拟评分(VAS)和Harris髋关节功能评分;并发症发生率。结果患者均获随访12~16个月[(14.1±1.4)个月]。双平面固定组手术时长为(75.1±15.3)min,长于PFNA组的(45.6±14.2)min(P<0.01);术中失血量为(234.1±11.8)ml,多于PFNA组的(170.0±13.4)ml(P<0.01);术后3 d血红蛋白水平为(82.6±9.3)g/L,高于PFNA组的(64.8±6.8)g/L(P<0.01);下地负重时间为(1.1±0.7)周,早于PFNA组的(3.2±1.2)周(P<0.01)。术后1、3、6个月及末次随访时,2组VAS和Harris髋关节功能评分差异均无统计学意义(P>0.05),且2组VAS和Harris髋关节功能评分均随术后时间延长逐渐改善(P<0.05或0.01)。2组均未出现神经血管损伤。双平面固定组发生下肢深静脉血栓(DVT)1例,并发症发生率为6.3%;PFNA组发生下肢DVT 2例,坠积性肺炎4例,并发症发生率为50.0%(P<0.05)。结论与PFNA内固定相比,虽然双平面固定联合植骨治疗重度骨质疏松性复杂股骨转子间骨折手术时长延长、术中失血量增多,但具有术后出血少、下地负重锻炼早和并发症发生率低的优势。Objective To compare the efficacy of biplanar fixation combined with bone grafting and proximal femoral nail anti⁃rotation(PFNA)in the treatment of critically complicated osteoporotic intertrochanteric femoral fracture.Methods A retrospective cohort study was conducted to analyze the clinical data of 28 patients with critically complicated osteoporotic intertrochanteric femoral fracture,admitted to Union Hospital,Tongji Medical College of Huazhong University of Science and Technology from January 2020 and December 2022,including 3 males and 25 females,aged 70⁃91 years[(79.4±6.3)years].T score for bone mineral density was-2.5~-4.1 SD[(-3.3±0.6)SD].All the patients were found with type A2.2-A3.3 fracture based on AO classification,and were complicated with trochanteric lateral wall fracture.Among them,16 patients underwent biplanar fixation combined with bone grafting(biplanar fixation group),while 12 underwent PFNA internal fixation(PFNA group).All the patients received anti⁃osteoporosis therapy after surgery.The two groups were compared in terms of the operative time,intraoperative blood loss,hemoglobin levels at 3 days postoperatively,and time to weight⁃bearing.The visual analogue scale(VAS)scores and Harris hip scores at 1,3,6 months postoperatively,and at the last follow⁃up and the incidence of complications were also detected in the two groups.Results All the patients were followed up for 12⁃16 months[(14.1±1.4)months].In the biplanar fixation group,the operative time was(75.1±15.3)minutes,significantly longer than(45.6±14.2)minutes in the PFNA group(P<0.01);the intraoperative blood loss was(234.1±11.8)ml,significantly more than(170.0±13.4)ml in the PFNA group(P<0.01);the hemoglobin level at 3 days postoperatively was(82.6±9.3)g/L in the biplanar fixation group,higher than(64.8±6.8)g/L in the PFNA group(P<0.01).The time to weight⁃bearing was(1.1±0.7)weeks in the biplanar fixation group,significantly shorter than(3.2±1.2)weeks in the PFNA group(P<0.01).There were no statistically signi

关 键 词：股骨骨折 骨质疏松 骨折固定术 内 

分 类 号：R683.42[医药卫生—骨科学]