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不同髓内固定方式治疗股骨转子间骨折的临床观察

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目的:探讨股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)、InterTan髓内钉和股骨近端仿生型髓内钉(proximal femoral bionic intramedullary nail,PFBN)治疗股骨转子间骨折的临床疗效。方法:回顾性分析2020年1月至2021年1月收治的120例接受闭合复位髓内钉内固定术股骨转子间骨折患者的临床资料,根据内固定方式分为3组。PFBN组25例,女16例,男9例,年龄69~79(73。67±5。16)岁;PFNA组55例,女38例,男17例,年龄68-80(74。23±5。57)岁;InterTan组40例,女26例,男14例,年龄68~79(73。45±5。34)岁。比较3组手术时间、术中出血量、切口长度、术后住院时间、负重时间及骨折愈合时间和并发症发生情况,分别于术前和术后1、6、12个月采用髋关节功能Harris评分进行临床疗效评价。结果:3组患者顺利完成手术,术后均随访12个月以上。3组住院时间、手术时间、术中出血量、切口长度比较,差异无统计学意义(P>0。05)。PFBN组、InterTan组负重时间[(7。98±1。34)d、(8。22± 0。46)d],早于 PFNA 组(10。27±0。66)d(P<0。01);PFBN 组、InterTan 组骨折愈合时间[(10。14±2。33)周、(11。87± 2。48)周],优于 PFNA 组(13。68±2。36)周(P<0。01)。术后 1 个月,PFBN 组、InterTan 组 Harris 评分[(70。52±5。34)分、(6981±617)分],高于 PFNA 组(51。46±5。36)分(P<0。01),PFBN 组和 InterTan 组比较,差异无统计学意义(P>0。05)。3组术前及术后6、12个月Harris评分比较,差异无统计学意义(P>0。05)。InterTan组、PFNA组并发症发生率低于PFNA组(P<0。05)。结论:PFBN和InterTan髓内钉治疗股骨转子间骨折较传统PFNA具有骨折愈合更快、负重时间更早且术后并发症更少的优势,但3种术式均可达到较高的有效率且远期效果无明显差异。
Clinical observation of different intramedullary fixation methods for the treatment of intertrochanteric fracture
Objective To explore clinical efficacy of proximal femoral nail anti-rotation(PFNA),InterTan and proximal femoral bionic intramedullary nail(PFBN)in treating femoral intertrochanteric fracture.Methods Clinical data of 120 patients with intertrochanteric fracture who were underwent closed reduction intramedullary nail-internal fixation from January 2020 to January 2021 were retrospectively analyzed.According to methods of internal fixation,patients were divided into 3 groups.There were 25 patients in PFBN group,including 16 females and 9 males,aged from 69 to 79 years old with an average of(73.67±5.16)years old.There were 55 patients in PFNA group,including 38 females and 17 males,aged from 68 to 80 years old with an average of(74.23±5.57)years old.There were 40 patients in InterTan group,including 26 females and 14 males,aged from 68 to 79 years old with an average of(73.45±5.34)years old.Operative time,intraoperative blood loss,incision length,hospital stay,weight-bearing time,fracture healing time and complications among 3 groups were compared,and clinical effect was evaluated by Harris score of hip function before operation,1,6 and 12 months after opertaion,respectively.Results Patients among 3 groups were successfully completed operation and were followed up for more than 12 months.There were no significant difference in hospital stay,operative time,intraoperative blood loss and incision length among 3 groups(P>0.05).Weight bearing time of PFBN group(7.98±1.34)d and InterTan group(8.22±0.46)d were earlier than that of PFNA group(10.27±0.66)d(P<0.01).Fracture healing time of PFBN group(10.14±2.33)weeks and InterTan group(11.87±2.48)weeks were earlier than that of PFNA group(13.68±2.36)weeks(P<0.01).One month after operation,Harris score in PFBN group(70.52±5.34)and InterTan group(69.81±6.17)was higher than that of PFNA group(51.46±5.36),and there was no signifi-cant difference between PFBN group and InterTan group(f>0.05).There were no significant difference in Harris scores among 3 groups before operation,6 and 12 months after opertaion(P>0.05).Cases of complication of InterTan group and PFNA group were lower than that of PFNA group(P<0.05).Conclusion PFBN and InterTan for the treatment of intertrochanteric fracture have advantages of faster fracture healing,earlier weight-bearing time and fewer postoperative complications than traditional PFNA,but three operations could achieve higher effective rates without significant difference in long-term results.

Intertrochanteric fractureFemoral intramedullary nailPostoperative complication

金立昆、李晔、张杰、董延旭、齐越峰

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北京市丰盛中医骨伤专科医院,北京 100033

股骨转子间骨折 股骨髓内钉 术后并发症

北京市优秀人才项目

SD2019-12

2024

中国骨伤
中国中西医结合学会,中国中医研究院

中国骨伤

CSTPCD
影响因子:1.876
ISSN:1003-0034
年,卷(期):2024.37(3)
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