摘要
目的 研究股骨近端防旋髓内钉(proximal femoral nail anti-rotation, PFNA)、联合加压交锁髓内钉系统(TriGen InterTAN hip fracture nailing system, InterTAN)、股骨近段锁定钢板(proximal femoral locking compression plate, PF-LCP)在治疗老年股骨粗隆间骨折中的临床效果。方法 采用回顾性研究的方式,收集2019年1月至2020年8月收治的老年粗隆间骨折患者146例,男67例,女79例;年龄62~84岁,平均(76.42±8.86)岁。按照手术方式不同,分为PFNA组50例、InterTAN组48例和PF-LCP组48例。比较3组患者手术时间、术中出血量、术中透视次数、下床活动时间、负重锻炼时间、骨折愈合时间、术后6个月Harris评分及并发症发生情况等。结果 146例患者术后获随访8~16个月。在手术时间、术中出血量方面,PFNA组优于InterTAN组,InterTAN组优于PF-LCP组,差异均有统计学意义(P<0.05);PF-LCP组在术中透视次数少于PFNA组和InterTAN组,差异有统计学意义(P<0.05);下床活动时间、负重锻炼时间和骨折愈合时间方面,InterTAN组优于PFNA组,PFNA组优于PF-LCP,差异有统计学意义(P<0.05);术后6个月Harris评分方面,PFNA组与InterTAN组之间无明显统计学差异(P>0.05),但2组均优于均PF-LCP组,差异均有统计学意义(P<0.05);在术后并发症方面,InterTAN组优于PFNA组,PFNA组优于PF-LCP,差异有统计学意义(P<0.05)。结论 对于老年粗隆间骨折,PFNA和InterTAN的治疗效果要优于股骨近端锁定钢板,可以提高骨折复位质量,有效降低术后并发症,促进骨折愈合和髋关节功能恢复。PFNA操作简单,手术时间短,出血量更少,适合不能耐受长时间手术的患者,而InterTAN具有更好的抗旋稳定性,内固定失效的发生率更低,这两种内固定方式各有优势,需要根据患者自身情况,进行合理选择。
Objective To study the clinical effect of proximal femoral nail anti-rotation(PFNA),TriGen InterTAN hip fracture nailing system(InterTAN)and proximal femoral locking compression plate(PF-LCP)on intertrochanteric femoral fracture in elderly patients.Methods It was a retrospective study involving 146 elderly patients with intertrochanteric femoral fracture,including 67 males and 79 females with the mean age of(76.42±8.86)years.According to the different surgical methods,they were divided into PFNA group(n=50),InterTAN group(n=48)and PF-LCP group(n=48).The operation time,intraoperative blood loss,intraoperative fluoroscopy frequency,time to get out of bed,time of weight bearing exercise,fracture healing time,Harris score at the last follow-up,and the status of complications were compared among the three groups.Results A total of 146 patients were postoperatively followed up for 8~16 months.Operation time and intraoperative blood loss were significantly less in PFNA group than those of InterTAN and PF-LCP group,which were significantly less in InterTAN group than those of PF-LCP group(P<0.05).The time of intraoperative fluoroscopy frequency was significantly less in PF-LCP group than that of the other two groups(P<0.05).Time to get out of bed,time of weight bearing exercise and fracture healing time were significantly earlier in InterTAN group than those of PFNA group,which were significantly earlier in PFNA group than those of PF-LCP group(P<0.05).No significant differences in Harris scores at 6 months postoperatively were detected between PFNA group and InterTAN group(P>0.05),which,in both groups were significantly better than those of PF-LCP group(P<0.05).The incidence of postoperative complications was significantly lower in InterTAN group than that of PFNA group,which was significantly lower in PFNA group than that of PF-LCP group(P<0.05).Conclusion PFNA and InterTAN have better therapeutic effects than PF-LCP on elderly intertrochanteric fractures,which can improve the quality of fracture reduction,reduce postoperative complications,and promote fracture healing and hip function recovery.PFNA is simple to operate,with short operation time and less bleeding,which is suitable to those who cannot tolerate long-term surgery.InterTAN has a better anti-rotation stability,and lower incidence of internal fixation failure.These two internal fixation methods have their own advantages,and they should be optionally selected based on the individualized condition.
作者
田志
鲍文娟
陈佳
李文毅
高尚聚
杨朝旭
李冠青
TIAN Zhi;BAO Wenjuan;CHEN Jia(Department of Orthopedics,Hebei General Hospital,Hebei,Shijiazhuang 050057,China)
出处
《河北医药》
CAS
2023年第4期558-561,共4页
Hebei Medical Journal
基金
河北省医学科学研究重点课题(编号:20190321)。
关键词
粗隆间骨折
股骨近端防旋髓内钉
InterTAN髓内钉
股骨近段锁定钢板
效果分析
intertrochanteric femoral fracture
proximal femoral nail anti-rotation
InterTan intramedullary nail
proximal femoral locking compression plate
curative effect analysis
作者简介
通讯作者:李文毅,E-mail:444631147@qq.com。
