两种髓内钉固定股骨干骨折合并同侧髋部骨折的疗效比较

COMPARISON OF PROXIMAL FEMORAL NAIL ANTIROTATION AND RECONSTRUCTION NAIL FOR IPSILATERAL FRACTURES OF HIP AND FEMORAL SHAFT

目的比较防旋型股骨近端髓内钉(proximal femoral nail antirotation,PFNA)与重建钉微创治疗青壮年股骨干骨折合并同侧髋部"囊外型"骨折的疗效。方法回顾性分析2000年1月-2010年8月采用PFNA和重建钉微创治疗的69例青壮年股骨干骨折合并同侧髋部"囊外型"骨折患者临床资料,其中重建钉组44例,PFNA组25例。两组患者性别、年龄、体重、致伤原因、骨折类型及受伤至手术时间比较,差异均无统计学意义(P>0.05),具有可比性。对两组手术时间、术中失血量、骨折愈合时间、并发症及髋、膝关节功能等进行比较。结果 PFNA组手术时间及术中失血量均明显少于重建钉组,差异有统计学意义(P<0.05)。69例均获1年以上随访,PFNA组随访时间12～38个月,平均20个月;重建钉组随访时间12～48个月,平均22个月。两组均无伤口感染、深静脉血栓形成、肺栓塞、内固定断裂、股骨头缺血性坏死及肢体严重旋转与短缩畸形等并发症发生。术中PFNA组植钉困难1例,重建钉组近端锁钉技术困难7例;术中PFNA组医源性股骨干骨折3例,重建钉组6例;术后PFNA组股骨干骨折延迟愈合1例,重建钉组2例;PFNA组和重建钉组并发症发生率分别为20%(5/25)和34%(15/44),比较差异无统计学意义(χ2=1.538,P=0.215)。两组各部位骨折愈合时间比较差异均无统计学意义(P>0.05)。末次随访时,两组髋关节Harris评分和膝关节Evanich评分比较差异均无统计学意义(P>0.05)。结论 PFNA与重建钉固定股骨干骨折合并同侧髋部"囊外型"骨折的临床疗效均满意,但PFNA具有操作简便等优点。

Objective To compare the effectiveness of proximal femoral nail antirotation （PFNA） and reconstruction nail with minimally invasive technique for ipsilateral femoral shaft and extracapsular hip fractures in young and middle- aged patients. Methods Sixty-nine young and middle-aged patients with ipsilateral femoral shaft and extracapsular hip fractures were treated between January 2000 and August 2010, and their data were analyzed retrospectively. Of them, fractures were fixed by reconstruction nail in 44 cases （reconstruction nail group） and by PFNA in 25 cases （PFNA group）. There was no significant difference in gender, age, weight, injury cause, fracture type, or disease duration between 2 groups （P 〉 0.05）. The operation time, blood loss, fracture healing time, complications, and functional outcomes were compared between 2 groups to evaluate the effectiveness. Results The operation time and blood loss in the PFNA group were significantly less than those in the reconstruction nail group （P 〈 0.05）. The follow-up time was 12-38 months （mean, 20 months ） in the PFNA group and was 12-48 months （mean, 22 months） in the reconstruction nail group. No complication occurred as follows in 2 groups： wound infection, deep venous thrombosis, pulmonary embolism, breakage of the implants, avascular necrosis of the femoral head, or serious rotation and shortening deformity of lower limbs. In the PFNA group and the reconstruction nail group, 1 patient underwent technical difficulty in nail implant and 7 patients underwent technical difficulty in proximal locking screw, respectively; 3 patients and 6 patients had intra-operative iatrogenic fracture of femoral shaft, respectively; and delayed union of femoral shaft was observed in 1 patient and 2 patients, respectively. The complication rate was 20% （5/25） in the PFNA group and 34% （15/44） in the reconstruction nail group, showing no significant difference （χ2=1.538, P=0.215）. No significant difference was found in fracture healing time between 2 groups （P 〉 0.05）. At last follow-up, there was no significant difference in Harris hip score and Evanich knee score between 2 groups （P 〉 0.05）. Conclusion PFNA or reconstruction nail withminimally invasive technique is a good method to treat ipsilateral femoral shaft and extracapsular hip fractures, but the PFNA is superior to the reconstruction nail because of simple operation.