摘要
目的比较微创经皮钢板固定技术(minimally invasive percutaneous plate osteosynthesis,MIPPO)重建外侧壁联合股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)固定与单纯闭合复位Intertan髓内钉固定治疗外侧壁不完整的国际内固定研究协会/美国骨创伤协会(AO/OTA)31-A3.3型股骨转子间骨折临床疗效。方法回顾分析2012年1月—2018年1月收治的54例符合选择标准的AO/OTA 31-A3.3型股骨转子间骨折患者临床资料。根据手术方式不同分为A组(锁定钢板MIPPO重建外侧壁联合PFNA内固定,24例)和B组(单纯闭合复位Intertan髓内钉内固定,30例)。两组患者性别、年龄、受伤侧别、致伤原因及合并内科疾病等一般资料比较差异均无统计学意义(P>0.05)。记录并比较两组患者手术时间、术中出血量、术后开始下地时间、骨折愈合时间及术后并发症。术后2 d、2个月及1年测量尖顶距(tip apex distance,TAD)。术后12个月根据Harris评分标准评价髋关节功能,并计算合格率(Harris评分>70分)。结果两组患者切口均Ⅰ期愈合,无感染等切口并发症发生。A组手术时间、术中出血量明显多于B组,术后开始下地时间、骨折愈合时间明显少于B组(P<0.05)。所有患者均获随访,随访时间A组9~20个月,平均14.7个月;B组9~19个月,平均13.8个月。两组间术后2 d、2个月及1年TAD值比较差异均无统计学意义(P>0.05);组内术后各时间点间TAD值比较差异亦无统计学意义(P>0.05)。术后B组出现1例感染、1例退钉、2例螺钉切出、1例骨不连,并发症发生率为16.7%;A组仅出现1例退钉合并螺旋刀片退出,并发症发生率为4.2%;两组并发症发生率比较差异无统计学意义(χ~2=2.109,P=0.146)。术后12个月,A组Harris评分的疼痛、功能、畸形和关节活动度评分及总分均明显优于B组(P<0.05)。其中A组合格率为95.83%(23/24),B组合格率为76.67%(23/30),两组合格率比较差异有统计学意义(χ~2=3.881,P=0.049)。结论针对外侧壁不完整的AO/OTA 31-A3.3型股骨转子间骨折,与单纯闭合复位Intertan髓内钉固定相比,MIPPO重建外侧壁联合PFNA固定术后内固定失效发生率更低,患者术后开始下地时间更早,术后功能恢复更好。
Objective To compare the effectiveness of proximal femoral nail anti-rotation(PFNA)combined with minimally invasive percutaneous plate osteosynthesis(MIPPO)and Intertan intramedullary nail fixation by closed reduction in the treatment of AO/Orthopaedic Trauma Association(AO/OTA)type 31-A3.3 intertrochanteric fracture with incomplete lateral wall.Methods The clinical data of 54 patients with AO/OTA type 31-A3.3 intertrochanteric fracture who met the selection criteria and were admitted between January 2012 and January 2018 were retrospectively analyzed.According to different surgical methods,the patients were divided into group A(24 cases with lateral wall reconstruction by MIPPO combined with PFNA internal fixation)and group B(30 cases with Intertan intramedullary nail fixation by closed reduction only).There was no significant difference between the two groups(P>0.05)in terms of gender,age,side of injury,cause of injury,and combined medical diseases.The operation time,intraoperative blood loss,time to weight-bearing,fracture healing time,and postoperative complications were recorded and compared between the two groups.The tip apex distance(TAD)was measured at 2 days,2 months,and 1 year after operation.At 12 months after operation,the hip joint function was evaluated according to Harris scoring standard,and the rate of conformity(Harris score were more than 70)was calculated.Results The wounds of the two groups healed by first intention,without infection,skin deformity,and other incision complications.The operation time and intraoperative blood loss of group A were significantly more than those of group B,and the time to weight-bearing and fracture healing were significantly shorter than those of group B(P<0.05).The patients were followed up 9-20 months(mean,14.7 months)in group A and 9-19 months(mean,13.8 months)in group B.There was no significant difference in TAD values at 2 days,2 months,and 1 year after operation between the two groups(P<0.05),and there was also no significant difference in TAD values between the postoperative time points(P>0.05).There was 1 case of infection,1 case of screw withdrawal,2 cases of screw removal,and 1 case of bone nonunion in group B,the incidence of complications was 16.7%;there was only 1 case of screw withdrawal combined with screw blade withdrawal in group A,the incidence of complications was 4.2%;there was no significant difference between the two groups(χ2=2.109,P=0.146).At 12 months after operation,the Harris scores of pain,function,malunion,range of motion,and total score in group A were significantly better than those in group B(P<0.05).The rate of conformity of group A was 95.83%(23/24)and 76.67%(23/30)in group B,and the difference between the two groups was significant(χ2=3.881,P=0.049).Conclusion For the AO/OTA type 31-A3.3 intertrochanteric fracture with incomplete lateral wall,compared with the closed reduction Intertan intramedullary nail fixation,the incidence of internal fixation failure after MIPPO reconstruction with lateral wall combined with PFNA fixation was lower,the time to weight-bearing was earlier,and the postoperative function was better.
作者
陈漳鑫
胡翠玉
郑振华
江惠祥
高明明
吴本文
黄国锋
丁真奇
CHEN Zhangxin;HU Cuiyu;ZHENG Zhenhua;JIANG Huixiang;GAO Mingming;WU Benwen;HUANG Guofeng;DING Zhenqi(Military Orthopaedic Center,the 909th Hospital of Joint Service Support Force of PLA(the Affiliated Dongnan Hospital of Xiamen University),Zhangzhou Fujian,363000,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2020年第9期1085-1090,共6页
Chinese Journal of Reparative and Reconstructive Surgery
基金
军队后勤科研项目(CNJ16C013)
军队青年医学科技培育项目(19QNP046)。
关键词
股骨转子间骨折
外侧壁
闭合复位
微创经皮钢板固定技术
股骨近端防旋髓内钉
Intertan髓内钉
内固定
Intertrochanteric fracture of femur
lateral wall
closed reduction
minimally invasive percutaneous plate osteosynthesis
proximal femoral nail anti-rotation
Intertan intramedullary nail
internal fixation
作者简介
通信作者:黄国锋,Email:huangguofeng175@163.com;通信作者:丁真奇,Email:dingzhenqi175@163.com。
