PFNA与InterTan髓内钉治疗老年股骨粗隆间骨折的疗效比较

Comparison of the efficacy of PFNA and InterTan intramedullary nail in the treatment ofintertrochanteric fractures in the elderly

目的比较PFNA与InterTan髓内钉治疗老年股骨粗隆间骨折的临床疗效。方法选择2016年10月—2018年10月在本院手术治疗的80例老年股骨粗隆间骨折患者作为研究对象,其中采用PFNA治疗(PFNA组)41例,InterTan髓内钉治疗(InterTan组)39例。比较两组手术时间、术中出血量、骨折愈合时间,以及术后3、6、12个月髋关节Harris评分和术后并发症发生率。结果80例患者均获12个月随访。PFNA组的手术时间短于InterTan组,术中出血量少于InterTan组,差异有统计学意义(P<0.05)。InterTan组骨折愈合较PFNA组快,差异有统计学意义(P<0.05)。InterTan组术后3个月髋关节Harris评分与PFNA组差异无统计学意义(P>0.05),但术后6和12个月髋关节Harris评分高于PFNA组,差异具有统计学意义(P<0.05)。InterTan组术后并发症发生率明显低于PFNA组,差异具有统计学意义(P<0.05)。结论PFNA与InterTan治疗老年股骨粗隆间骨折均能取得较好的早期临床疗效,但InterTan内固定在抗旋转稳定性及轴向加压作用方面要优于PFNA内固定,内固定的失效率明显少于PFNA,可以让患者更早下床活动,获得更好的髋关节功能,减少卧床并发症。

Objective To compare the clinical effect of proximal femoral nail antirotation(PFNA)and Intertan intramedullary nail in the treatment of intertrochanteric fracture in the elderly.Methods 80 elderly patients suffered from intertrochanteric fractures those got surgical treatment in our hospital from October 2016 to 0ctober 2018 were enrolled as study subjects.41 out of the 80 patients were treated with PFNA(PFNA group)and the other 39 cases treated with intertan intramedullary nails(InterTan group).The operation time,intraoperative blood loss,fracture healing time,Hip Harris score at 3rd,6th and 12th month after operation and postoperative complications were compared between the two groups.Results All the 80 patients were followed up for 12 months.The operation time of PFNA group was shorter than that of InterTan group,and the amount of bleeding during operation was less than that of InterTan group,the difference was statistically significant(P<0.05).The fracture healing in InterTan group was earlyer than that in PFNA group,and the difference was statistically significant(P<0.05).There was no significant difference in Harris score of hip joint between InterTan group and PFNA group at 3rd month after operation(P>0.05),but the Harris score of hip joint at 6th and 12th month after operation was significantly higher than that in PFNA group(P<0.05).The incidence of postoperative complications in the Intertan group was significantly lower than that of the PFNA group(P<0.05).Conclusions Both PFNA and InterTan nail could achieve good early clinical effect in the treatment of intertrochanteric fracture of femur in the elderly,but InterTan nail fixation is superior to PFNA internal fixation in anti-rotation stability and axial compression,the failure rate of internal fixation is significantly lower than that of PFNA,and patients could get out of bed earlier,restore hip joint function and reduce the bed rest induced complications.