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[1]江孝龍,蔣國華,孫賢杰.股骨近端防旋髓內(nèi)釘內(nèi)固定與動(dòng)力髖螺釘內(nèi)固定治療老年股骨轉(zhuǎn)子間骨折的對比研究[J].中醫(yī)正骨,2019,31(02):8-13.
　JIANG Xiaolong,JIANG Guohua,SUN Xianjie.A comparative study of internal fixation with proximal femoral nail antirotation versus dynamic hip screw for treatment of intertrochanteric fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(02):8-13.
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股骨近端防旋髓內(nèi)釘內(nèi)固定與動(dòng)力髖螺釘內(nèi)固定治療老年股骨轉(zhuǎn)子間骨折的對比研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期數(shù):
2019年02期
頁碼:
8-13
欄目:
臨床研究
出版日期:
2019-02-20

文章信息/Info

Title:
A comparative study of internal fixation with proximal femoral nail antirotation versus dynamic hip screw for treatment of intertrochanteric fractures in the aged
作者:
江孝龍; 蔣國華; 孫賢杰
(浙江省榮軍醫(yī)院,浙江 嘉興 314000)
Author(s):
JIANG Xiaolong; JIANG Guohua; SUN Xianjie
Zhejiang Rongjun Hospital,Jiaxing 314000,Zhejiang,China
關(guān)鍵詞:
髖骨折;  轉(zhuǎn)子間骨折;  老年人;  骨折固定術(shù); 內(nèi);  股骨近端防旋髓內(nèi)釘;  動(dòng)力髖螺釘;  療效比較研究
Keywords:
hip fractures;  intertrochanteric fractures;  aged;  fracture fixation; internal;  proximal femoral nail antirotation;  dynamic hip screw;  comparative effectiveness research
摘要:
目的:比較股骨近端防旋髓內(nèi)釘(proximal femoral nail antirotation,PFNA)內(nèi)固定與動(dòng)力髖螺釘(dynamic hip screw,DHS)內(nèi)固定治療老年股骨轉(zhuǎn)子間骨折的臨床療效和安全性。方法:回顧性分析95例老年股骨轉(zhuǎn)子間骨折患者的病例資料,其中采用PFNA內(nèi)固定治療52例(PFNA組),采用DHS內(nèi)固定治療43例(DHS組)。男38例,女57例。年齡60～91歲,中位數(shù)67歲。按照股骨轉(zhuǎn)子間骨折的Evans分型,Ⅰ型39例、Ⅱ型56例。比較2組患者的術(shù)中出血量、手術(shù)時(shí)間、住院時(shí)間、骨折愈合時(shí)間、Harris髖關(guān)節(jié)功能評分及并發(fā)癥發(fā)生情況。結(jié)果:①一般指標(biāo)。PFNA組患者手術(shù)時(shí)間、住院時(shí)間均短于DHS組[(73.6±11.3)min,(83.6±13.2)min,t=4.058,P=0.000;(15.4±6.9)d,(17.6±7.8)d,t=3.655,P=0.000],術(shù)中出血量小于DHS組[(168.2±19.6)mL,(219.3±25.5)mL,t=11.039,P=0.000]; 2組患者骨折愈合時(shí)間比較,差異無統(tǒng)計(jì)學(xué)意義[(15.3±3.3)周,(16.7±5.8)周,t=1.371,P=0.174]。②Harris髖關(guān)節(jié)功能評分。時(shí)間因素和分組因素不存在交互效應(yīng)(F=0.164,P=0.721); 2組患者Harris髖關(guān)節(jié)功能評分比較,組間差異無統(tǒng)計(jì)學(xué)意義,即不存在分組效應(yīng)(F=0.317,P=0.752); 手術(shù)前后不同時(shí)間點(diǎn)Harris髖關(guān)節(jié)功能評分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=31.253,P=0.000); 2組患者Harris髖關(guān)節(jié)功能評分隨時(shí)間均呈上升趨勢,且2組的上升趨勢完全一致[(38.2±8.2)分,(86.6±5.9)分,(88.4±5.0)分,(90.2±5.2)分,F=40.328,P=0.000;(40.7±9.3)分,(84.7±6.8)分,(86.5±5.2)分,(88.7±6.3)分,F=22.453,P=0.000]。③綜合療效。術(shù)后24個(gè)月,PFNA組臨床治愈27例、顯效21例、有效2例、無效2例,DHS組臨床治愈17例、顯效19例、有效5例、無效2例; 2組患者綜合療效比較,差異無統(tǒng)計(jì)學(xué)意義(Z=-1.407,P=0.159)。④安全性。PFNA組3例發(fā)生螺旋刀片部分或完全切出,1例出現(xiàn)髖內(nèi)翻,1例出現(xiàn)骨折延遲愈合。DHS組5例出現(xiàn)螺釘退出,1例出現(xiàn)斷釘,3例出現(xiàn)股骨頸短縮,3例出現(xiàn)髖內(nèi)翻,2例出現(xiàn)下肢深靜脈血栓,2例出現(xiàn)骨折延遲愈合。PFNA組患者并發(fā)癥發(fā)生率低于DHS組(χ2=10.408,P=0.001)。結(jié)論:PFNA內(nèi)固定與DHS內(nèi)固定治療老年股骨轉(zhuǎn)子間骨折,均能促進(jìn)髖關(guān)節(jié)功能恢復(fù),二者的臨床療效和骨折愈合時(shí)間相當(dāng),但前者較后者手術(shù)時(shí)間短、術(shù)中出血量少、住院時(shí)間短、并發(fā)癥少。
Abstract:
Objective:To compare the clinical curative effects and safety of internal fixation with proximal femoral nail antirotation(PFNA)versus dynamic hip screw(DHS)in treatment of intertrochanteric fractures in the aged.Methods:The medical records of 95 aged patients with intertrochanteric fractures were analyzed retrospectively.Fifty-two patients were treated with PFNA internal fixation(PFNA group),while the others were treated with DHS internal fixation(DHS group).The patients consisted of 38 males and 57 females,and ranged in age from 60 to 91 years(Median=67 yrs).According to the Evans classification of intertrochanteric fractures,the fractures belonged to typesⅠ(39)andⅡ(56).The intraoperative blood loss,operative time,hospital stay,fracture healing time,Harris hip function scores and complications were compared between the 2 groups.Results:The operative time and hospital stay were shorter and the intraoperative blood loss was less in PFNA group compared to DHS group(73.6+/-11.3 vs 83.6+/-13.2 min,t=4.058,P=0.000; 15.4+/-6.9 vs 17.6+/-7.8 days,t=3.655,P=0.000; 168.2+/-19.6 vs 219.3+/-25.5 mL,t=11.039,P=0.000).There was no statistical difference in the fracture healing time between the 2 groups(15.3+/-3.3 vs 16.7+/-5.8 weeks,t=1.371,P=0.174).There was no interaction between time factor and group factor in Harris hip function scores(F=0.164,P=0.721).There was no statistical difference in Harris hip function scores between the 2 groups,in other words,there was no group effect(F=0.317,P=0.752).There was statistical difference in Harris hip function scores between different timepoints before and after the surgery,in other words,there was time effect(F=31.253,P=0.000).The Harris hip function scores presented a time-dependent increasing trend in the 2 groups,and the 2 groups were consistent with each other in the increasing trend of Harris hip function scores(38.2+/-8.2,86.6+/-5.9,88.4+/-5.0,90.2+/-5.2 points,F=40.328,P=0.000; 40.7+/-9.3,84.7+/-6.8,86.5+/-5.2,88.7+/-6.3 points,F=22.453,P=0.000).At 24 months after the surgery,27 patients were cured,21 good,2 fair and 2 poor in PFNA group; while 17 patients were cured,19 good,5 fair and 2 poor in DHS group.There was no statistical difference in the total curative effects between the 2 groups(Z=-1.407,P=0.159). Partial or complete protrusion of spiral blade(3 cases),coxa vara(1 case)and delayed union of fracture(1 case)were found in PFNA group,while screw withdrawal(5 cases),screw breakage(1 case),femoral neck shortening(3 cases),coxa vara(3 cases),lower extremity deep venous thrombosis(2 cases)and delayed union of fracture(2 cases)were found in DHS group.The complication incidence was lower in PFNA group compared to DHS group(χ2=10.408,P=0.001).Conclusion:Both PFNA internal fixation and DHS internal fixation can promote hip function recovery in treatment of intertrochanteric fractures in the aged,and they are similar to each other in clinical curative effect and fracture healing time,however,the former has such advantages as shorter operative time and hospital stay,less intraoperative blood loss and complications compared to the latter.

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(收稿日期:2018-11-06 本文編輯:時(shí)紅磊)
更新日期/Last Update: 2019-02-20