基于闭合复位PFNA内固定探讨其对股骨转子间骨折稳定性及抗扭转性影响的临床研究  

Clinical investigation on the impact of closed reduction and PFNA for intertrochanteric femoral fractures on stability and torsional resistance

作　　者：周梧节 金颖颖 陈作喜 许兵 ZHOU Wujie;JIN Yingying;CHEN Zuoxi;XU Bing(Department of TraumaⅡ,Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Zhejiang Chinese Medical University,Wenzhou 325008,China;Outpatient Department,Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Zhejiang Chinese Medical University,Wenzhou 325008,China;Department of Science and Education,Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Zhejiang Chinese Medical University,Wenzhou 325008,China)

机构地区：[1]浙江中医药大学附属温州中西医结合医院创伤二科,浙江温州325008 [2]浙江中医药大学附属温州中西医结合医院门诊部,浙江温州325008 [3]浙江中医药大学附属温州中西医结合医院科教科,浙江温州325008

出　　处：《空军军医大学学报》2025年第3期372-377,共6页Journal of Air Force Medical University

基　　金：浙江省医药卫生科技计划项目(2022KY1209);温州市基础性医疗卫生科研项目(Y20210440)。

摘　　要：目的探讨闭合复位股骨近端螺旋刀片抗旋髓内钉(PFNA)内固定治疗对股骨转子间骨折稳定性及抗扭转性的影响。方法选择2021年9月至2023年2月浙江中医药大学附属温州中西医结合医院收治的90例股骨转子间骨折患者为研究对象,按随机数表法分为两组,对照组给予动力髋螺钉治疗,观察组给予闭合复位PFNA内固定治疗。比较两组手术情况;术后6个月骨折复位情况、髋关节活动角度、并发症发生情况;术后第1、3、7日疼痛情况[疼痛评分量表(NRS)评分];术前、术后6个月运动功能和日常生活活动能力[髋关节功能(Harris评分)、膝关节评分(HSS)、日常生活活动能力(Barthel评分)];利用三维有限元分析法测试术后6个月200、400、600 N时垂直压缩状态下位移情况和扭转角为1°、3°、5°时的扭矩。结果观察组住院时间、手术时间、骨折愈合时间均短于对照组,术中出血量少于对照组(P<0.01);术后第1、3、7日两组患者在静息和运动两种状态下的NRS评分观察组均低于对照组(P<0.05);术后6个月两组骨折复位情况比较差异均无统计学意义(P>0.05);术后6个月,两组髋关节各项活动角度均增大,且观察组大于对照组(P<0.05);术后6个月,两组患者Harris评分、HSS、Barthel评分均升高,且观察组均高于对照组(P<0.05);观察组在200、400、600 N垂直压缩状态下的位移均小于对照组,观察组扭转角为1°、3°、5°时的扭矩均大于对照组(P<0.05);术后6个月固定松动、移位、旋转失稳并发症的总发生率观察组低于对照组(P<0.05)。结论闭合复位PFNA内固定治疗股骨转子间骨折效果较理想,可促进术后恢复,改善关节功能,提升稳定性及抗扭转能力并减少并发症发生。Objective To investigate the impact of closed reduction and proximal femoral nail antirotation(PFNA)on the stability and torsional resistance of intertrochanteric femoral fractures.Methods A total of 90 patients with intertrochanteric femoral fractures admitted to Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine affiliated to Zhejiang Chinese Medical University from September 2021 to February 2023 were selected as the study objects.They were divided into two groups according to random number table method.The control group was given dynamic hip screw fixation,and the observation group was given closed reduction and PFNA fixation.The study compared the surgical outcomes of the two groups,including fracture alignment,hip joint mobility,and postoperative complication rates six months after surgery;pain levels at 1,3,and 7 d after surgery[Numerical Rating Scale(NRS)];and motor function and activities of daily living before and 6 months after surgery[hip joint function(Harris Hip Score),Hospital for Special Surgery Knee Score(HSS),and activities of daily living(Barthel Index)].Additionally,three-dimensional finite element analysis was employed to measure displacement under vertical loads of 200,400,and 600 N,and torque resistance at 1°,3°,and 5°of torsion six months after surgery.Results The observation group demonstrated reduced hospital stay,operative duration,and time to fracture consolidation compared to the control group,with less intraoperative blood loss(P<0.01).NRS scores of the observation group were lower than those of the control group at 1,3,and 7 d after surgery at rest and during exercise(P<0.05).No significant difference in fracture alignment was observed between the two groups at six months after surgery(P>0.05).Both groups experienced an increase in hip joint mobility,with the observation group demonstrating a more significant enhancement compared to the control group at six months after surgery(P<0.05).Harris Hip Score,HSS and Barthel Index in both groups were increased,and t

关 键 词：闭合复位 近端螺旋刀片抗旋髓内钉 股骨转子间骨折 稳定性 抗扭转性 影响 

分 类 号：R687.3[医药卫生—骨科学]