PFNA及倒置LISS钢板治疗股骨近端骨折的对比研究

Comparison of PFNA and reverse LISS in the treatment of proximal femoral fractures

目的探讨股骨近端螺旋刀片抗旋髓内钉（proximal femoral nail antirotation blade，PFNA）和倒置股骨远端锁定接骨板（1ess invasive stabilization system，LISS）治疗股骨近端骨折合并髋内翻畸形患者的临床疗效并进行对比分析。方法回顾性分析2007年6月至2010年6月采用PFNA和倒置LISS钢板内固定治疗且随访时间超过10个月的股骨近端骨折合并髋内翻畸形患者46例的病例资料，采用PFNA内固定治疗者24例，采用倒置LISS钢板内固定治疗者22例。所有患者术后6h开始不负重状态下功能锻炼。对比分析两组患者术前美国麻醉学会（American society of anesthesiologists，ASA）评分、手术时间和术中失血量、术后完全负重时间、骨折愈合时间、Parker-Palmer活动评分和颈干角角度丢失的情况。结果所有患者获得10～12个月随访，平均11．2个月。两组术前ASA评分、手术时间、术中失血量和末次随访Parker-Palmer活动评分的差异均无统计学意义。倒置LISS钢板组完全负重时间和骨折愈合时间较PFNA组延长，颈干角角度丢失减少。结论PFNA固定允许患者早期负重；但对于骨质疏松严重、内固定切割风险较高的患者，倒置LISS钢板固定有助于降低术后髋内翻的发生率。

Objective To evaluate and compare the clinical effects of proximal femoral nail antiro- tation blade （PFNA） with reverse less invasive stabilization system-distal femur （LISS） in the treatment of proximal femoral fractures associated with coxa vara. Methods From June 2007 to June 2010, A retrospec- tive study with more than l0 months follow-up of 46 patients with proximal femoral fractures associated with coxa vara underwent PFNA or reverse LISS were carried out, including 24 with PFNA and 22 patients with reverse LISS. The physical status of patient was evaluated according to the American Society of Anesthesiolo- gists （ASA） score. After the operation, the operation duration and volume of blood loss were assessed in the two groups, respectively. At the last follow-up, full weight bearing time, fracture healing time, and neck-shaft angle discrepancy related to coritralateral side without fracture of the each group were assessed, respectively. Functional recovery was evaluated according to Parker and Palmer mobility score. Results The average fol- low-up period was 11.2 months （range, 10-12）. All the fractures healed successfully and reached bony union. There were no significant differences between PFNA group and reverse LISS group for the average ASA score, the average operating time, the average volume of intraoperative bleeding and Parker and Palmer mo- bility score. The patients were allowed full weight-bearing from 9.33 weeks after surgery in PFNA group and from 16.95 weeks in reverse LISS group. The patients reached bony union after 17.21 weeks after surgery in PFNA group and from 30.73 weeks in reverse LISS group. Comparing with PFNA group, neck-shaft angle discrepancy decreased in reverse LISS group. Conclusion The results of PFNA and reverse LISS in the treatment of proximal femoral fracture were satisfactory. The fracture treated by PFNA allowed earlier weight bearing. Reverse LISS could orovide better support for neck-shaft anale to avoid coxa vara more effectively.