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[1]張雨,李鈞,李志民,等.解剖型髓內(nèi)釘內(nèi)固定和股骨近端防旋髓內(nèi)釘內(nèi)固定治療老年股骨轉(zhuǎn)子間骨折的比較研究[J].中醫(yī)正骨,2022,34(03):15-19.
　ZHANG Yu,LI Jun,LI Zhimin,et al.A comparative study of internal fixation with Zimmer natural nail versus proximal femoral nail antirotation for treatment of intertrochanteric fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(03):15-19.
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解剖型髓內(nèi)釘內(nèi)固定和股骨近端防旋髓內(nèi)釘內(nèi)固定治療老年股骨轉(zhuǎn)子間骨折的比較研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期數(shù):
2022年03期
頁(yè)碼:
15-19
欄目:
臨床研究
出版日期:
2022-03-20

文章信息/Info

Title:
A comparative study of internal fixation with Zimmer natural nail versus proximal femoral nail antirotation for treatment of intertrochanteric fractures in the aged
作者:
張雨; 李鈞; 李志民; 黃鶴; 水明斌
(浙江新安國(guó)際醫(yī)院,浙江 嘉興 314033)
Author(s):
ZHANG Yu; LI Jun; LI Zhimin; HUANG He; SHUI Mingbin
Zhejiang Xin'an International Hospital,Jiaxing 314033,Zhejiang,China
關(guān)鍵詞:
髖骨折;  老年人;  骨折固定術(shù); 髓內(nèi);  股骨近端防旋髓內(nèi)釘;  解剖型髓內(nèi)釘
Keywords:
hip fractures;  aged;  fracture fixation; intramedullary;  proximal femoral nail antirotation;  Zimmer natural nail
摘要:
目的:比較解剖型髓內(nèi)釘(Zimmer natural nail,ZNN)內(nèi)固定和股骨近端防旋髓內(nèi)釘(proximal femoral nail antirotation,PFNA)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:對(duì)122例老年股骨轉(zhuǎn)子間骨折患者的病例資料進(jìn)行回顧性分析,接受ZNN內(nèi)固定治療的62例為ZNN組,接受PFNA內(nèi)固定治療的60例為PFNA組。比較2組患者手術(shù)時(shí)間、術(shù)中X線透視次數(shù)、術(shù)中出血量、住院時(shí)間、骨折愈合時(shí)間、下地行走時(shí)間、完全負(fù)重時(shí)間、并發(fā)癥發(fā)生率,以及術(shù)后3個(gè)月和術(shù)后12個(gè)月時(shí)的髖部疼痛視覺模擬量表(visual analogue scale,VAS)評(píng)分和Harris髖關(guān)節(jié)評(píng)分。結(jié)果:①一般結(jié)果。與PFNA組相比,ZNN組手術(shù)時(shí)間和住院時(shí)間短[(70.11±6.16)min,(81.53±7.57)min,t=5.326,P=0.000;(6.43±1.45)d,(8.25±1.37)d,t=3.326,P=0.000],術(shù)中X線透視次數(shù)和出血量少[(3.16±0.57)次,(5.75±1.28)次,t=4.834,P=0.000;(180.01±12.64)mL,(202.84±11.23)mL,t=4.574,P=0.000]。②療效評(píng)價(jià)結(jié)果。2組患者骨折均愈合,ZNN組骨折愈合時(shí)間較PFNA組短[(4.27±0.82)周,(6.46±0.98)周,t=6.890,P=0.000],下地行走時(shí)間和完全負(fù)重時(shí)間均較PFNA組早[(16.35±3.16)d,(22.54±3.37)d,t=5.642,P=0.000;(22.46±4.36)周,(29.74±5.32)周,t=6.323,P=0.000]。術(shù)后3個(gè)月,2組患者髖部疼痛VAS評(píng)分和Harris髖關(guān)節(jié)評(píng)分比較,組間差異均無(wú)統(tǒng)計(jì)學(xué)意義[(5.21±2.12)分,(5.22±1.73)分,t=0.251,P=0.523;(52.52±3.43)分,(54.51±2.76)分,t=0.532,P=0.243]; 術(shù)后12個(gè)月,ZNN組髖部疼痛VAS評(píng)分低于PFNA組[(1.22±0.26)分,(3.75±0.68)分,t=5.623,P=0.000],Harris髖關(guān)節(jié)評(píng)分高于PFNA組[(93.51±4.23)分,(81.95±3.99)分,t=8.431,P=0.000]; 與術(shù)后3個(gè)月相比,術(shù)后12個(gè)月時(shí)2組患者髖部疼痛VAS評(píng)分均降低(t=4.523,P=0.000; t=7.654,P=0.000),Harris髖關(guān)節(jié)評(píng)分均提高(t=7.534,P=0.000; t=8.564,P=0.000)。③安全性評(píng)價(jià)結(jié)果。ZNN組并發(fā)切口感染1例,應(yīng)用抗生素后感染控制。PFNA組并發(fā)切口感染5例,應(yīng)用抗生素后感染控制; 并發(fā)髖關(guān)節(jié)骨關(guān)節(jié)炎2例,經(jīng)康復(fù)訓(xùn)練后,髖關(guān)節(jié)功能有所改善。ZNN組并發(fā)癥發(fā)生率與PFNA組相比,差異無(wú)統(tǒng)計(jì)學(xué)意義(χ2=3.523,P=0.061)。結(jié)論:ZNN內(nèi)固定治療老年股骨轉(zhuǎn)子間骨折,比PFNA內(nèi)固定手術(shù)時(shí)間和住院時(shí)間短,術(shù)中X線透視次數(shù)和出血量少,骨折愈合快,術(shù)后下地行走和完全負(fù)重早,更有利于緩解髖部疼痛和恢復(fù)髖關(guān)節(jié)功能,但二者安全性相當(dāng)。
Abstract:
Objective:To compare the clinical efficacy and safety of internal fixation with Zimmer natural nail(ZNN)versus proximal femoral nail antirotation(PFNA)for treatment of intertrochanteric fractures(ITFs)in the aged.Methods:The medical records of 122 aged patients with ITFs were analyzed retrospectively.Sixty-two patients were treated with ZNN internal fixation(ZNN group),while the others with PFNA internal fixation(PFNA group).The operative time,intraoperative X-ray exposure,intraoperative blood loss,hospital stays,fracture healing time,bed rest time,complete weight-bearing walk start time and complication incidence rate were compared between the 2 groups,furthermore,the hip pain visual analogue scale(VAS)score and Harris hip score measured at 3 and 12 months after the surgery were compared between the 2 groups.Results:①The operative time and hospital stays were shorter,the intraoperative X-ray exposure was fewer and the intraoperative blood loss was less in ZNN group compared to PFNA group(70.11±6.16 vs 81.53±7.57 minutes,t=5.326,P=0.000; 6.43±1.45 vs 8.25±1.37 days,t=3.326,P=0.000; 3.16±0.57 vs 5.75±1.28 times,t=4.834,P=0.000; 180.01±12.64 vs 202.84±11.23 mL,t=4.574,P=0.000).②All fractures healed in the 2 groups,and the fracture healing time was shorter in ZNN group compared to PFNA group(4.27±0.82 vs 6.46±0.98 weeks,t=6.890,P=0.000),and the bed rest time and complete weight-bearing walk start time were shorter in ZNN group compared to PFNA group(16.35±3.16 vs 22.54±3.37 days,t=5.642,P=0.000; 22.46±4.36 vs 29.74±5.32 weeks,t=6.323,P=0.000).There was no statistical difference in hip pain VAS score and Harris hip score between the 2 groups at 3 months after the surgery(5.21±2.12 vs 5.22±1.73 points,t=0.251,P=0.523; 52.52±3.43 vs 54.51±2.76 points,t=0.532,P=0.243).The hip pain VAS score was lower while the Harris hip score was higher in ZNN group compared to PFNA group at 12 months after the surgery(1.22±0.26 vs 3.75±0.68 points,t=5.623,P=0.000; 93.51±4.23 vs 81.95±3.99 points,t=8.431,P=0.000).The hip pain VAS score decreased and the Harris hip score increased in the 2 groups at 12 months after the surgery compared with that at 3 months after the surgery(t=4.523,P=0.000; t=7.654,P=0.000; t=7.534,P=0.000; t=8.564,P=0.000).③The incision infection was found in 1 patient in ZNN group and 5 cases in PFNA group,and the infection was controlled after application of antibiotics.Moreover,the hip osteoarthritis was found in 2 patients in PFNA group,and the hip function was improved after rehabilitation training.There was no statistical difference in complication incidence rate between the 2 groups(χ2=3.523,P=0.061).Conclusion:ZNN internal fixation has such advantages as shorter operative time,hospital stays,bed rest time and complete weight-bearing walk start time,fewer intraoperative X-ray exposure,less intraoperative blood loss and faster fracture healing,furthermore,it can be more conducive to hip pain remission and hip function recovery compared to PFNA internal fixation in treatment of ITFs in the aged,whereas the two methods are similar to each other in the safety.

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(收稿日期:2021-09-17 本文編輯:楊雅)

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通訊作者:水明斌 E-mail:[email protected]
更新日期/Last Update: 1900-01-01