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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:

第25卷

期數(shù):

2013年06期

頁(yè)碼:

20-23

欄目:

臨床研究

出版日期:

2013-06-30

文章信息/Info

Title:

Comparison of proximal femoral nail antirotation and dynamic hip screw for the treatment of intertrochanteric fractures

作者:

徐雍劍

浙江省常山縣人民醫(yī)院,浙江 常山 324200

Author(s):

XU Yong-jian

People's Hospital of Changshan,Changshan 324200,Zhejiang,China

關(guān)鍵詞:

髖骨折 轉(zhuǎn)子間骨折 骨折固定術(shù); 內(nèi) 抗旋轉(zhuǎn)型股骨近端髓內(nèi)釘 動(dòng)力髖螺釘

Keywords:

Hip fractures;  Intertrochanteric fractures;  Fracture fixation; internal;  Proximal femoral nail antirotation;  Dynamic hip screw

摘要:

目的:比較抗旋轉(zhuǎn)型股骨近端髓內(nèi)釘內(nèi)固定與動(dòng)力髖螺釘內(nèi)固定治療股骨轉(zhuǎn)子間骨折的臨床療效及安全性。方法:將納入研究的51例股骨轉(zhuǎn)子間骨折患者隨機(jī)分為2組,26例采用抗旋轉(zhuǎn)型股骨近端髓內(nèi)釘內(nèi)固定,25例采用動(dòng)力髖螺釘內(nèi)固定。其中Evans-JensenⅠa型5例,Ⅰb型10例,Ⅱa型11例,Ⅱb型12例,Ⅲ型13例。觀察并比較2組患者手術(shù)時(shí)間、術(shù)中出血量、術(shù)后開(kāi)始下地負(fù)重行走時(shí)間、骨折愈合時(shí)間及術(shù)后并發(fā)癥發(fā)生情況,并對(duì)2組患者治療前后Harris髖關(guān)節(jié)功能評(píng)分進(jìn)行比較。結(jié)果:①一般情況。2組患者手術(shù)時(shí)間比較,差異無(wú)統(tǒng)計(jì)學(xué)意義[(45±8)min,(46±9)min,t=12.653,P=0.150]; 抗旋轉(zhuǎn)型股骨近端髓內(nèi)釘組患者術(shù)中出血量少于動(dòng)力髖螺釘組[(310±110)mL,(400±140)mL,t=9.234,P=0.020],術(shù)后開(kāi)始下地負(fù)重行走時(shí)間早于動(dòng)力髖螺釘組[(12±7)d,(25±8)d,t=8.702,P=0.020]。②臨床療效。抗旋轉(zhuǎn)型股骨近端髓內(nèi)釘組患者的骨折愈合時(shí)間比動(dòng)力髖螺釘組短[(13.2±2.7)周,(17.2±3.3)周,t=3.478,P=0.020]。2組患者術(shù)后的Harris髖關(guān)節(jié)功能評(píng)分均較治療前增加; 抗旋轉(zhuǎn)型股骨近端髓內(nèi)釘組患者的髖關(guān)節(jié)功能、運(yùn)動(dòng)范圍及綜合評(píng)分的增加值均高于動(dòng)力髖螺釘組[(30.2±3.3)分,(16.7±3.0)分,t=2.570,P=0.004;(2.4±0.6)分,(1.1±0.5)分,t=2.620,P=0.006;(62.1±3.8)分,(46.1±3.7)分,t=3.322,P=0.000],而髖關(guān)節(jié)畸形評(píng)分的增加值低于動(dòng)力髖螺釘組[(1.3±0.4)分,(4.5±0.7)分,t=2.837,P=0.003]; 2組患者髖關(guān)節(jié)疼痛評(píng)分的增加值比較,差異無(wú)統(tǒng)計(jì)學(xué)意義[(26.7±2.7)分,(26.9±2.9)分,t=0.988,P=0.150]。③安全性。術(shù)后抗旋轉(zhuǎn)型股骨近端髓內(nèi)釘組1例患者出現(xiàn)髖關(guān)節(jié)畸形,1例患者出現(xiàn)內(nèi)固定松動(dòng); 動(dòng)力髖螺釘組術(shù)后1例患者出現(xiàn)感染,5例患者出現(xiàn)髖關(guān)節(jié)畸形,5例患者術(shù)后出現(xiàn)內(nèi)固定松動(dòng)。抗旋轉(zhuǎn)型股骨近端髓內(nèi)釘組患者術(shù)后并發(fā)癥發(fā)生率低于動(dòng)力髖螺釘組(χ2=8.846,P=0.003)。結(jié)論:對(duì)于Evans-JensenⅠ、Ⅱ、Ⅲ型股骨轉(zhuǎn)子間骨折患者而言,與動(dòng)力髖螺釘內(nèi)固定相比,抗旋轉(zhuǎn)型股骨近端髓內(nèi)釘內(nèi)固定術(shù)中出血量少、骨折愈合時(shí)間早、術(shù)后可早期進(jìn)行功能鍛煉及下地負(fù)重行走、術(shù)后并發(fā)癥少、髖關(guān)節(jié)功能恢復(fù)好,是治療股骨轉(zhuǎn)子間骨折的理想手術(shù)方式。

Abstract:

Objective:To compare the general conditions,clinical curative effects and safety between the therapy of proximal femoral nail antirotation(PFNA)fixation and the therapy of dynamic hip screw(DHS)fixation for the treatment of intertrochanteric fractures.Methods:Fifty-one patients with intertrochanteric fractures were included into the study and were divided into 2 groups.Twenty-six patients were administrated with PFNA fixation(PFNA group),while the others were administrated with DHS fixation(DHS group).The fractures belonged to Evans-Jensen typesⅠa(5),Ⅰb(10),Ⅱa(11),Ⅱb(12)andⅢ(13).The 2 groups were compared with each other in such parameters as operative time,blood loss,bed rest time,fracture healing time,Harris scores and the incidence rate of complications.Results:The blood loss,bed rest time and fracture healing time of PFNA group were all lower than those of DHS group respectively((310±110)mL vs(400±140)mL,t=9.234,P=0.020;(12±7)d vs(25±8)d,t=8.702,P=0.020;(13.2±2.7)weeks vs(17.2±3.3)weeks,t=3.478,P=0.020),while there were no statistical differences in operative time betwee the 2 groups((45±8)min vs(46±9)min,t=12.653,P=0.150).After the treatment,the scores of pain,function,deformity,range of motion(ROM)and Harris total scores all increased in the 2 groups.The increased value of function scores,ROM scores and Harris total scores of PFNA group were all greater than those of DHS group((30.2±3.3)vs(16.7±3.0),t=2.570,P=0.004;(2.4±0.6)vs(1.1±0.5),t=2.620,P=0.006;(62.1±3.8)vs(46.1±3.7),t=3.322,P=0.000),and the increased value of deformity scores of PFNA group was less than that of DHS group((1.3±0.4)vs(4.5±0.7),t=2.837,P=0.003),while there was no statistical difference in increased value of pain scores between the 2 groups((26.7±2.7)vs(26.9±2.9),t=0.988,P=0.150).One patient with hip joint deformitiy and 1 patient with loosening internal fixation were found in PFNA group,while 1 patient with infection,5 patients with hip joint deformitiy and 5 patients with loosening internal fixation were found in DHS group.The incidence rate of complications was lower in PFNA group compared with that in DHS group(χ2=8.846,P=0.003).Conclusion:Compared with DHS fixation,the therapy of PFNA fixation has such advantages as less blood loss,shorter fracture healing time,shorter bed rest time,less complications and better function of hip joint for the treatment of Evans-Jensen typeⅠ,Ⅱ,and Ⅲ intertrochanteric fractures.

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更新日期/Last Update: 1900-01-01