目的 研究老年Evans-JensenⅤ型股骨转子间骨折患者应用股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定联合钛缆重建外侧壁及内侧壁治疗的临床效果.方法 随机选取2022年1月—2023年12月南宁市第三人民医院收治的80例Evans-JensenⅤ型股骨转子间骨折患者作为研究对象,按照治疗方法不同分为两组,对照组(40例)实施PFNA内固定治疗,观察组(40例)实施PFNA联合钛缆重建外侧壁及内侧壁治疗,观察并比较两组患者围术期指标、术后12个月股骨颈长度和颈干角变化、临床疗效、术后Harris髋关节功能评分(疼痛、功能、关节活动度、肢体畸形).结果 两组患者术中失血量、手术操作时间比较,差异无统计学意义(P均＞0.05),但观察组患者术后下地活动时间、骨折愈合时间均短于对照组,差异有统计学意义(P均＜0.05).术后即刻,两组患者股骨颈长度、颈干角情况比较,差异无统计学意义(P均＞0.05);术后12个月,观察组股骨颈长度短于对照组,颈干角小于对照组,差异有统计学意义(P均＜0.05).术前,两组患者Harris髋关节功能评分比较,差异无统计学意义(P＞0.05);术后12个月,观察组患者Harris髋关节功能评分(疼痛、功能、关节活动度、肢体畸形)均高于对照组,差异有统计学意义(P均＜0.05).观察组患者治疗有效率为97.50%(39/40),高于对照组的75.00%(30/40),差异有统计学意义(χ2=8.537,P＜0.05).结论 PFNA联合钛缆重建外侧壁及内侧壁治疗老年Evans-JensenⅤ型股骨转子间骨折患者,可达到稳定内固定及早期负重活动并恢复良好的关节功能的治疗目标.
Therapeutic Effect of Proximal Femoral Nail Antirotation Combined with Titanium Cable Reconstruction of Lateral Wall and Medial Wall in Treat-ment of Intertrochanteric Fracture of Senile Evans-Jensen V
Objective To investigate the clinical effect of using proximal femoral nail antirotation(PFNA)intramedul-lary nail fixation combined with titanium cable to reconstruct the lateral and medial walls in elderly patients with Evans-Jensen V intertrochanteric fractures.Methods A total of 80 patients with Evans-Jensen V intertrochanteric fracture admitted to the Third People's Hospital of Nanning from January 2022 to December 2023 were randomly se-lected as the study objects and divided into two groups according to different treatment methods.The control group(40 cases)was treated with PFNA internal fixation,and the observation group(40 cases)was treated with PFNA combined with titanium cable to reconstruct the lateral wall and medial wall.Perioperative indexes,changes of femoral neck length and cervical trunk angle 12 months after surgery,clinical effect of internal fixation,and Harris Hip Function score(pain,function,range of motion,limb deformity)were observed and compared between the two groups.Results There was no statistically significant difference in the intraoperative blood loss and operation time between the two groups(both P＞0.05),but the postoperative ground movement time and fracture healing time in the observation group were shorter than those in the control group,and the differences were statistically significant(both P＜0.05).Immedi-ately after surgery,there was no significant difference in femoral neck length and trunk angle between the two groups(both P＞0.05).12 months after surgery,the length of femoral neck in the observation group was shorter than that in the control group,and the trunk angle of the neck was smaller than that in the control group,the differences were statisti-cally significant(both P＜0.05).Before operation,there was no significant difference in Harris Hip Function score be-tween two groups(P＞0.05).12 months after surgery,the Harris Hip Function scores(pain,function,joint motion,limb deformity)in observation group were higher than those in control group,and the differences were statistically signifi-cant(all P＜0.05).The effective rate of treatment in the observation group was 97.50%(39/40),which was higher than 75.00%(30/40)in the control group,and the difference was statistically significant(χ2=8.537,P＜0.05).Conclusion The reconstruction of external and internal walls by PFNA combined with titanium cable in the treatment of senile Evans-Jensen V femoral intertrochanteric fracture can achieve the therapeutic goals of stable internal fixation,early weight-bearing activities and recovery of good joint function.
Hip fractureIntertrochanteric fractureProximal femoral nail antirotationTitanium cable reconstruction
万方数据
维普
