后内侧壁骨折块复位固定对PFNA治疗股骨粗隆间骨折合并后内侧壁骨折的临床效果

Clinical effect of posteromedial wall fracture reduction and fixation on PFNA in the treatment of intertrochanteric fracture of femoral complicated with posteromedial wall fracture

目的探讨后内侧壁骨折块复位固定对股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)治疗股骨粗隆间骨折合并后内侧壁骨折的临床效果。方法回顾性分析2020年1月~2022年1月沭阳县中医院收治的64例股骨粗隆间骨折合并后内侧壁骨折患者的资料。所有患者均行PFNA治疗,根据是否采用后内侧壁骨折块复位固定分为未复位组(n=29例)和复位组(n=35例)。比较2组患者手术时间、术中出血量、负重时间、骨折愈合时间,髋关节活动度,视觉模拟疼痛评分(visual analogue scale,VAS)、髋关节功能评分、下肢功能评分以及并发症发生情况。结果复位组患者手术时间长于未复位组(P<0.05),2组术中出血量比较,差异无统计学意义(P>0.05)。复位组患者负重时间、骨折愈合时间均短于未复位组(P<0.05);术后6个月,2组患者髋关节前屈、后伸、外展、内收活动度较术后1个月均增加(P<0.05),且复位组患者髋关节前屈、后伸、外展、内收活动度高于未复位组(P<0.05);术后3个月,2组患者VAS评分较术后10 d均降低(P<0.05),且复位组患者VAS评分低于未复位组(P<0.05);术后6个月,2组患者髋关节功能评分、下肢功能评分较术后1个月均升高(P<0.05),且复位组患者髋关节功能评分、下肢功能评分均高于未复位组(P<0.05);2组患者并发症发生率比较,差异无统计学意义(P>0.05)。结论后内侧壁骨折块复位固定用于PFNA治疗股骨粗隆间骨折合并后内侧壁骨折患者,可以加快术后恢复,减轻术后疼痛,改善髋关节和下肢功能,安全可靠。

Objective To explore the clinical effect of medial wall fracture block reduction and fixation on proximal femoral nail antirotation(PFNA)in the treatment of posterior medial wall fracture of intertrochanteric fracture of femur.Methods The data of 64 patients with intertrochanteric fracture of femur and posterior medial wall fracture admitted to Shuyang County Hospital of Traditional Chinese Medicine from January 2020 to January 2022 were analyzed retro-spectively.All patients were treated with PFNA,and they were divided into non reduction group(n=29 cases)and reduction group(n=35 cases)according to receive or not to receive reduction and fixation of medial wall fracture block.The operation time,intraoperative blood loss,hospitalization time,weight bearing time,fracture healing time,hip joint mobility,visual analog pain score(VAS),hip joint function score,lower limb function score and complications of the two groups were compared.Results The operation time in the reduction group was longer than that in the non reduction group(P<0.05).There was no significant difference in the amount of bleeding in both groups(P>0.05).The hospitalization time,weight bearing time and fracture healing time of patients in the reduction group were shorter than those in the non reduction group(P<0.05).Six months after operation,the flexion,extension,abduction and adduction of the hip joint in the two groups were increased compared with that in one month after operation(P<0.05),and the flexion,extension,abduction and adduction of the hip joint in the reduction group were higher than those in the non reduction group(P<0.05).After 3 months of operation,VAS scores of patients in both groups were decreased compared with that in 10 days after operation(P<0.05),and VAS scores of patients in reduction group were lower than those in non reduction group(P<0.05).Six months after operation,the hip joint function score and lower limb function score of patients in both groups increased compared with that in one month after operation(P<0.05),and the hip joint function score and lower limb function score of patients in the reduction group were higher than those in the non reduction group(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion The reduction and fixation of medial wall fracture block can be used for PFNA treatment of patients with medial wall fracture after intertrochanteric fracture of femur,and it can accelerate postoperative recovery,reduce postoperative pain,improve hip joint and lower limb function,and it is safe and reliable.