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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

關鍵詞:

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

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組患者手術時間、術中出血量、術后開始下地負重行走時間、骨折愈合時間及術后并發(fā)癥發(fā)生情況,并對2組患者治療前后Harris髖關節(jié)功能評分進行比較。結(jié)果:①一般情況。2組患者手術時間比較,差異無統(tǒng)計學意義[(45±8)min,(46±9)min,t=12.653,P=0.150]; 抗旋轉(zhuǎn)型股骨近端髓內(nèi)釘組患者術中出血量少于動力髖螺釘組[(310±110)mL,(400±140)mL,t=9.234,P=0.020],術后開始下地負重行走時間早于動力髖螺釘組[(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間比動力髖螺釘組短[(13.2±2.7)周,(17.2±3.3)周,t=3.478,P=0.020]。2組患者術后的Harris髖關節(jié)功能評分均較治療前增加; 抗旋轉(zhuǎn)型股骨近端髓內(nèi)釘組患者的髖關節(jié)功能、運動范圍及綜合評分的增加值均高于動力髖螺釘組[(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],而髖關節(jié)畸形評分的增加值低于動力髖螺釘組[(1.3±0.4)分,(4.5±0.7)分,t=2.837,P=0.003]; 2組患者髖關節(jié)疼痛評分的增加值比較,差異無統(tǒng)計學意義[(26.7±2.7)分,(26.9±2.9)分,t=0.988,P=0.150]。③安全性。術后抗旋轉(zhuǎn)型股骨近端髓內(nèi)釘組1例患者出現(xiàn)髖關節(jié)畸形,1例患者出現(xiàn)內(nèi)固定松動; 動力髖螺釘組術后1例患者出現(xiàn)感染,5例患者出現(xiàn)髖關節(jié)畸形,5例患者術后出現(xiàn)內(nèi)固定松動。抗旋轉(zhuǎn)型股骨近端髓內(nèi)釘組患者術后并發(fā)癥發(fā)生率低于動力髖螺釘組(χ2=8.846,P=0.003)。結(jié)論:對于Evans-JensenⅠ、Ⅱ、Ⅲ型股骨轉(zhuǎn)子間骨折患者而言,與動力髖螺釘內(nèi)固定相比,抗旋轉(zhuǎn)型股骨近端髓內(nèi)釘內(nèi)固定術中出血量少、骨折愈合時間早、術后可早期進行功能鍛煉及下地負重行走、術后并發(fā)癥少、髖關節(jié)功能恢復好,是治療股骨轉(zhuǎn)子間骨折的理想手術方式。

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