PFNA-Ⅱ治疗高龄不稳定型股骨转子间骨折中期疗效分析

Mid-term effect of PFNA-Ⅱin the treatment of unstable intertrochanteric fracture in elderly patients

目的探讨亚洲型防旋股骨近端髓内钉(PFNA-Ⅱ)治疗高龄不稳定型股骨转子间骨折患者的疗效。方法回顾性分析徐州市中心医院2019年4月—2022年4月收治的103例高龄不稳定型股骨转子间骨折患者的临床资料。根据采用的内固定材料分为A组(n=54,采用PFNA-Ⅱ)与B组(n=49,采用股骨近端解剖锁定钢板)。比较2组围手术期指标、髋关节功能、血栓弹力图参数[凝血反应时间(R值)、凝血形成时间(K值)、血凝块形成速率(α角)]、大腿疼痛程度(VAS评分)、日常生活能力(VDL评分)及并发症。结果A组手术时间、住院时间及术后负重时间均短于B组,术中出血量均明显少于B组,组间比较差异具有统计学意义(P<0.05),但2组骨折愈合时间比较差异无统计学意义(P>0.05)。A组疼痛改善程度明显优于B组(P<0.05),2组步态、功能性活动、运动范围、下肢畸形情况维度评分、Harris总分比较,差异无统计学意义(P>0.05)。术后2组R值较术前明显降低,α角明显增高,A组R值明显高于B组,α角低于B组(P<0.05)。2组手术前后K值比较无明显差异(P>0.05)。2组术后VAS评分明显较术前降低,ADL评分明显较术前增高,且A组VAS评分低于B组,ADL评分高于B组(P<0.05)。A组并发症总发生率为5.56%,B组并发症总发生率为8.16%,组间比较无差异(P>0.05)。结论PFNA-Ⅱ治疗高龄不稳定型股骨转子间骨折可有效缩短手术时间,术中出血少、创伤小,有利于减少术后血栓形成,促进患者康复。

Objective To investigate the effectiveness of proximal femoral nail antirotation for Asian(PFNA-Ⅱ)in the treatment of elderly patients with unstable intertrochanteric fracture.Methods A total of 103 elderly patients with unstable intertrochanteric fracture who were admitted to Xuzhou Central Hospital from April 2019 to April 2022 were enrolled and their clncial data were retrospectively analyzed.According to the internal fixation materials used,they were divided into two groups:group A(n=54,using PFNA-II)and group B(n=49,using proximal femoral anatomical locking plate).Then,both groups were compared for perioperative indexes,hip joint function,thromboelastography parameters[coagulation reaction time(R value),coagulation formation time(K value),and blood clot formation rate(αangle)],thigh pain,activities of daily living and complications.Results Group A showed remarkably shorter operation time,length of hospitalization stay and postoperative weight-bearing time,as well as less intraoperative blood loss than group B(P<0.05),but no statistical difference was found in fracture healing time between the two groups(P>0.05).Pain improvement in group A was significantly better than that in group B(P<0.05).There was no statistical difference in gait,functional activity,range of motion,dimension score of lower extremity deformity,and Harris total score between the two groups(P>0.05).After operation,the R value of the two groups was significantly lower than those before operation,and theαangle significantly increased.Group A presented significantly higher R value and lowerαangle than group B(P<0.05).There was no statistical difference in K value between the two groups before and after surgery(P>0.05).The postoperative VAS scores of the two groups were significantly lower than those before surgery,but ADL scores were significantly higher than those before surgery.Group A presented significantly lower VAS score but higher ADL score than group B(P<0.05).The total incidence of complications was 5.56%in group A,and 8.16%in group B,without statistical difference(P>0.05).Conclusions Application of PFNA-Ⅱfor the treatment of unstable intertrochanteric fracture in elderly patients can effectively shorten operation time,with less intraoperative blood loss and less trauma,which is beneficial to reduce postoperative thrombosis and promote the recovery of patients.