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[1]鮑雷,馮冬前,余加生,等.骨水泥強(qiáng)化型與傳統(tǒng)型股骨近端防旋髓內(nèi)釘內(nèi)固定治療老年骨質(zhì)疏松性股骨轉(zhuǎn)子間不穩(wěn)定性骨折的對(duì)比研究[J].中醫(yī)正骨,2023,35(10):16-20,36.
　BAO Lei,FENG Dongqian,YU Jiasheng,et al.A comparative study of bone cement-reinforced versus conventional proximal femoral nail antirotation internal fixation for treatment of unstable osteoporotic intertrochanteric fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2023,35(10):16-20,36.
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骨水泥強(qiáng)化型與傳統(tǒng)型股骨近端防旋髓內(nèi)釘內(nèi)固定治療老年骨質(zhì)疏松性股骨轉(zhuǎn)子間不穩(wěn)定性骨折的對(duì)比研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期數(shù):
2023年10期
頁(yè)碼:
16-20,36
欄目:
臨床研究
出版日期:
2023-10-20

文章信息/Info

Title:
A comparative study of bone cement-reinforced versus conventional proximal femoral nail antirotation internal fixation for treatment of unstable osteoporotic intertrochanteric fractures in the aged
作者:
鮑雷1; 馮冬前1; 余加生1; 張斌1; 孫玉明2
1.沭陽(yáng)縣中醫(yī)院,江蘇 沭陽(yáng) 223600; 2.江蘇省中醫(yī)院,江蘇 南京 210029
Author(s):
BAO Lei1; FENG Dongqian1; YU Jiasheng1; ZHANG Bin1; SUN Yuming2
1.Shuyang Hospital of Traditional Chinese Medicine,Shuyang 223600,Jiangsu,China 2.Jiangsu Province Hospital of Chinese Medicine,Nanjing 210029,Jiangsu,China
關(guān)鍵詞:
髖骨折;  骨質(zhì)疏松性骨折;  股骨轉(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;  骨粘合劑
Keywords:
hip fractures;  osteoporotic fractures;  femoral intertrochanteric fracture;  aged;  fracture fixation; internal;  proximal femoral nail antirotation;  bone cements
摘要:
目的:比較骨水泥強(qiáng)化型與傳統(tǒng)型股骨近端防旋髓內(nèi)釘(proximal femoral nail antirotation,PFNA)內(nèi)固定治療老年骨質(zhì)疏松性股骨轉(zhuǎn)子間不穩(wěn)定性骨折的臨床療效和安全性。方法:回顧性分析60例老年骨質(zhì)疏松性股骨轉(zhuǎn)子間不穩(wěn)定性骨折患者的臨床資料,其中采用骨水泥強(qiáng)化型PFNA內(nèi)固定治療28例(骨水泥強(qiáng)化組)、采用傳統(tǒng)型PFNA內(nèi)固定治療32例(傳統(tǒng)組)。比較2組患者的手術(shù)時(shí)間、術(shù)中失血量、尖頂距(tip-apex distance,TAD)、術(shù)后輔助下負(fù)重時(shí)間、骨折愈合時(shí)間、并發(fā)癥發(fā)生率,以及術(shù)后3個(gè)月、6個(gè)月、12個(gè)月的Harris髖關(guān)節(jié)評(píng)分。結(jié)果:①一般指標(biāo)。骨水泥強(qiáng)化組患者手術(shù)時(shí)間長(zhǎng)于傳統(tǒng)組[(63.79±3.72)min,(58.06±4.52)min,t=5.309,P=0.000],術(shù)后輔助下負(fù)重時(shí)間、骨折愈合時(shí)間均短于傳統(tǒng)組[(4.39±1.66)d,(5.81±1.96)d,t=-3.003,P=0.004;(5.75±1.51)個(gè)月,(6.65±1.62)個(gè)月,t=-2.235,P=0.029]; 2組患者術(shù)中失血量、TAD的組間差異均無(wú)統(tǒng)計(jì)學(xué)意義[(69.29±10.78)mL,(67.19±10.77)mL,t=0.753,P=0.455;(22.29±1.80)mm,(22.47±1.85)mm,t=-0.387,P=0.700]。②Harris髖關(guān)節(jié)評(píng)分。術(shù)后3個(gè)月、6個(gè)月,骨水泥強(qiáng)化組Harris髖關(guān)節(jié)評(píng)分均高于傳統(tǒng)組[(70.07±5.33)分,(66.97±5.51)分,t=2.210,P=0.031;(83.00±2.57)分,(77.16±4.24)分,t=6.550,P=0.000]; 術(shù)后12個(gè)月,兩組Harris髖關(guān)節(jié)評(píng)分的差異無(wú)統(tǒng)計(jì)學(xué)意義[(90.25±3.42)分,(88.91±3.57)分,t=1.480,P=0.143]。③并發(fā)癥發(fā)生率。骨水泥強(qiáng)化組出現(xiàn)1例譫妄,傳統(tǒng)組出現(xiàn)2例骶尾部壓傷、2例墜積性肺炎、1例尿路感染、1例譫妄、2例螺旋刀片切出、1例退釘; 傳統(tǒng)組并發(fā)癥發(fā)生率高于骨水泥強(qiáng)化組(χ2=4.835,P=0.028)。結(jié)論:采用骨水泥強(qiáng)化型PFNA內(nèi)固定治療老年骨質(zhì)疏松性股骨轉(zhuǎn)子間不穩(wěn)定性骨折,與傳統(tǒng)型PFNA內(nèi)固定比較,患者術(shù)后輔助下負(fù)重早、骨折愈合快、髖關(guān)節(jié)功能恢復(fù)快,且安全性更高,但手術(shù)時(shí)間較長(zhǎng)。
Abstract:
Objective:To compare the clinical outcomes and safety of bone cement-reinforced versus conventional proximal femoral nail antirotation(PFNA)internal fixation in treatment of unstable osteoporotic intertrochanteric fractures in the aged.Methods:The clinical data of 60 patients with unstable osteoporotic intertrochanteric fractures were retrospectively analyzed.Twenty-eight patients were treated with bone cement-reinforced PFNA internal fixation(bone cement-reinforced group),and 32 ones with conventional PFNA internal fixation(conventional group).The operative time,intraoperative blood loss,tip-apex distance(TAD),postoperative partial weight-bearing walk start time,fracture healing time,complication incidence rate,and the Harris hip score evaluated at postoperative month 3,6 and 12 were compared between the 2 groups.Results:①The operative time was longer,the postoperative partial weight-bearing walk start time and fracture healing time were shorter in bone cement-reinforced group compared to conventional group(63.79±3.72 vs 58.06±4.52 minutes,t=5.309,P=0.000; 4.39±1.66 vs 5.81±1.96 days,t=-3.003,P=0.004; 5.75±1.51 vs 6.65±1.62 months,t=-2.235,P=0.029); while the comparison of intraoperative blood loss and TAD between the 2 groups revealed no significant differences(69.29±10.78 vs 67.19±10.77 mL,t=0.753,P=0.455; 22.29±1.80 vs 22.47±1.85 mm,t=-0.387,P=0.700).②The Harris hip score was higher in bone cement-reinforced group compared to conventional group at postoperative month 3 and 6(70.07±5.33 vs 66.97±5.51 points,t=2.210,P=0.031; 83.00±2.57 vs 77.16±4.24 points,t=6.550,P=0.000); while,at postoperative month 12,the difference between the 2 groups was not statistically significant(90.25±3.42 vs 88.91±3.57 points,t=1.480,P=0.143).③After the procedure,the delirium(1 case)was found in bone cement-reinforced group; while the sacrococcygeal compression injury(2 cases),hypostatic pneumonia(2 cases),urinary tract infection((1 case),delirium(1 case),spiral blade protrusion from femoral head(2 cases)and nail dropped out(1 case)were found in conventional group.The incidence rate of postoperative complications was lower in bone cement-reinforced group compared to conventional group(χ2=4.835,P=0.028).Conclusion:The bone cement-reinforced PFNA internal fixation displays the advantages of earlier postoperative partial weight-bearing walk,faster fracture healing and hip function recovery with higher safety,but the disadvantage of longer operative time compared to the conventional PFNA internal fixation in treatment of unstable osteoporotic intertrochanteric fractures in the aged.

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更新日期/Last Update: 1900-01-01