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[1]王守寶,楊峰,張振清,等.重建鎖定接骨板聯(lián)合股骨近端防旋髓內(nèi)釘內(nèi)固定治療合并外側(cè)壁破裂的A3型老年股骨轉(zhuǎn)子間骨折的臨床研究[J].中醫(yī)正骨,2022,34(12):23-28.
　WANG Shoubao,YANG Feng,ZHANG Zhenqing,et al.A clinical study of reconstruction locking plate and PFNA internal fixation for treatment of type A3 femoral intertrochanteric fractures complicated with lateral wall rupture in elderly patients[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(12):23-28.
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重建鎖定接骨板聯(lián)合股骨近端防旋髓內(nèi)釘內(nèi)固定治療合并外側(cè)壁破裂的A3型老年股骨轉(zhuǎn)子間骨折的臨床研究()
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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12期
頁碼:
23-28
欄目:
臨床研究
出版日期:
2022-12-02

文章信息/Info

Title:
A clinical study of reconstruction locking plate and PFNA internal fixation for treatment of type A3 femoral intertrochanteric fractures complicated with lateral wall rupture in elderly patients
作者:
王守寶; 楊峰; 張振清; 郝成俊
(淮安市第五人民醫(yī)院,江蘇 淮安 223300)
Author(s):
WANG Shoubao; YANG Feng; ZHANG Zhenqing; HAO Chengjun
The Fifth People's Hospital of Huai'an,Huai'an 223300,Jiangsu,China
關(guān)鍵詞:
髖骨折;  轉(zhuǎn)子間骨折;  骨折固定術(shù); 內(nèi);  股骨近端防旋髓內(nèi)釘;  鎖定鋼板;  臨床試驗(yàn)
Keywords:
hip fractures;  intertrochanteric fractures;  fracture fixation; internal;  proximal femoral nail antirotation;  locking plate;  clinical trial
摘要:
目的:觀察重建鎖定接骨板聯(lián)合股骨近端防旋髓內(nèi)釘(proximal femoral nail antirotation,PFNA)內(nèi)固定治療合并外側(cè)壁破裂的A3型老年股骨轉(zhuǎn)子間骨折的臨床療效和安全性。方法:回顧性分析40例合并外側(cè)壁破裂的A3型老年股骨轉(zhuǎn)子間骨折患者的病例資料,其中采用重建鎖定接骨板聯(lián)合PFNA內(nèi)固定治療20例(重建鎖定接骨板聯(lián)合PFNA組)、單純采用PFNA內(nèi)固定治療20例(PFNA組)。比較2組患者手術(shù)時(shí)間、術(shù)中出血量、住院時(shí)間、術(shù)后下地時(shí)間、骨折愈合時(shí)間、股骨偏心距短縮、尖頂距、Harris髖關(guān)節(jié)評分及并發(fā)癥發(fā)生率。結(jié)果:①一般結(jié)果。2組患者手術(shù)時(shí)間、術(shù)中出血量比較,組間差異均無統(tǒng)計(jì)學(xué)意義[(114.12±12.52)min,(105.24±10.61)min,t=1.724,P=0.062;(309.12±18.37)mL,(278.55±20.14)mL,t=1.956,P=0.059]; 重建鎖定接骨板聯(lián)合PFNA組患者住院時(shí)間、術(shù)后下地時(shí)間均短于PFNA組[(11.0±1.5)d,(17.3±2.3)d,t=2.510,P=0.041;(26.4±5.5)d,(41.0±6.2)d,t=2.131,P=0.012]。②療效評價(jià)結(jié)果。重建鎖定接骨板聯(lián)合PFNA組患者骨折愈合時(shí)間短于PFNA組[(9.8±1.2)周,(13.6±3.1)周,t=2.371,P=0.036]; 股骨偏心距短縮小于PFNA組[(0.3±0.2)mm,(0.8±0.1)mm,t=1.658,P=0.020]; 2組患者尖頂距比較,差異無統(tǒng)計(jì)學(xué)意義[(26.7±4.1)mm,(27.7±3.4)mm,t=0.245,P=0.120]。2組患者隨訪時(shí)間6～12個(gè)月,中位數(shù)7.5個(gè)月。末次隨訪時(shí),重建鎖定接骨板聯(lián)合PFNA組患者Harris髖關(guān)節(jié)評分高于PFNA組[(91.1±6.6)分,(83.1±6.4)分,t=3.036,P=0.005]。③安全性評價(jià)結(jié)果。重建鎖定接骨板聯(lián)合PFNA組1例發(fā)生主釘輕度上移,PFNA組2例發(fā)生主釘輕度上移、2例發(fā)生螺旋刀片后退及切出、1例發(fā)生主釘斷裂。2組患者并發(fā)癥發(fā)生率比較,差異無統(tǒng)計(jì)學(xué)意義(P=0.091)。結(jié)論:重建鎖定接骨板聯(lián)合PFNA內(nèi)固定治療合并外側(cè)壁破裂的A3型老年股骨轉(zhuǎn)子間骨折,與單純PFNA內(nèi)固定比較,患者下地活動(dòng)早,住院時(shí)間和骨折愈合時(shí)間短,髖關(guān)節(jié)功能恢復(fù)好,且安全性相當(dāng)。
Abstract:
Objective:To observe the clinical efficacy and safety of reconstruction locking plate and proximal femoral nail antirotation(PFNA)internal fixation in the treatment of type A3 femoral intertrochanteric fractures complicated with lateral wall rupture in elderly patients.Methods:The medical data of 40 elderly patients with type A3 femoral intertrochanteric fractures complicated with lateral wall rupture were retrospectively analyzed,including 20 cases treated with reconstruction locking plate and PFNA internal fixation(combination group)and 20 with PFNA internal fixation(PFNA group).The operation time,intraoperative blood loss,length of hospital stay,postoperative bed rest time,fracture healing time,decrease in femoral eccentric distance,tip apex distance(TAD),Harris Hip Score(HHS),and incidence of complications were compared between the two groups.Results:①General results.There was no significant difference in operation time and intraoperative blood loss between the two groups(114.12±12.52 vs 105.24±10.61 min,t=1.724,P=0.062; 309.12±18.37 vs 278.55±20.14 mL,t=1.956,P=0.059).The length of hospital stay and postoperative bed rest time of patients in the combination group were shorter than those in the PFNA group(11.0±1.5 vs 17.3±2.3 d,t=2.510,P=0.041; 26.4±5.5 vs 41.0±6.2 d,t=2.131,P=0.012).②Efficacy evaluation results.The fracture healing time of patients in the combination group was shorter than that in the PFNA group(9.8±1.2 vs 13.6±3.1 weeks,t=2.371,P=0.036),and the decrease in femoral eccentric distance was inferior to that in the PFNA group(0.3±0.2 vs 0.8±0.1 mm,t=1.658,P=0.020).There was no statistically significant difference in TAD between the two groups(26.7±4.1 vs 27.7±3.4 mm,t=0.245,P=0.120).Patients in both groups were followed up for 6-12 months,with a median of 7.5 months.At the last follow-up,the HHS of patients in the combination group was higher than that in the PFNA group(91.1±6.6 vs 83.1±6.4,t=3.036,P=0.005).③Safety evaluation results.In the combination group,one case underwent slight upward shift of the main nail.In the PFNA group,slight upward shift of the main nail occurred in two cases,spiral blade withdrawal and cutting out in two cases,and main nail fracture in one case.There was no significant difference in the incidence of complications between the two groups(P=0.091).Conclusion:Compared with PFNA internal fixation alone,reconstruction locking plate and PFNA internal fixation in the treatment of type A3 femoral intertrochanteric fractures complicated with lateral wall rupture in elderly patients can advance the postoperative bed rest time,shorten the length of hospital stay and fracture healing time,and improve the recovery of hip joint function,and the safety was equivalent.

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(收稿日期:2022-05-12 本文編輯:呂寧)

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