PFNA与PFNAⅡ治疗老年不稳定性股骨转子间骨折的疗效比较

Comparison of proximal femoral nail anti-rotation(PFNA) and PFNAⅡ in treatment of unstable femoral trochanteric fractures in elderly people

目的探讨股骨近端螺旋刀片抗旋髓内钉(PFNA)与其亚洲改进型(PFNAⅡ)在治疗老年不稳定性股骨转子间骨折中的近期疗效差异。方法随访2009年1月～2010年12月间完成的53例65岁以上不稳定性股骨转子间骨折病例,随访14～36个月,平均24.5个月。PFNA治疗组22例,PFNAⅡ组31例。记录并比较其年龄,骨折类型(AO分型),术前合并症,手术持续时间,术中出血量,围术期输血量,术后首次行走时间,测量术后初次X线片检查的尖顶距(TAD)并记录术后2周Harris评分;随访记录术后内固定有否切出股骨头,骨折愈合时间,术后12个月大腿疼痛情况及Harris评分等。结果两组病例术前差异不具有统计学意义(P>0.05);所有病例随访时间内未发现感染及骨折不愈合,无刀片切出股骨头;PFNAⅡ组手术持续时间低于PFNA组,术中出血量少于PFNA组,术后12个月大腿疼痛明显低于PFNA组,术后12个月Harris评分高于PFNA组,两组比较差异具有统计学意义(P<0.05);两组病例其余各项差异不具有统计学意义(P>0.05)。结论 PFNA和PFNAⅡ均可实现老年不稳定性股骨转子间骨折的良好固定;PFNAⅡ操作更为顺畅,可有效降低术后大腿疼痛发生率,更适合身材相对瘦小的亚洲老年不稳定性股骨转子间骨折患者。

Objective To compare the short-term effect of treating unstable femoral trochanteric fractures in elderly people with proximal femoral nail anti-rotation（PFNA） and PFNAⅡ.Methods Between Jan.2009 and Dec.2010,53 elderly patients with unstable femoral trochanteric fractures who underwent surgical treatment were enrolled,including 20 males and 33 females with an average age of 78.6 years（66-89 years old）.All patients were divided into PFNA group（22 cases） and PFNAⅡ group（31 cases） according to the internal fixation material.The follow-up period was 14 to 36 months（mean 24.5 months）.The operation time,intra-operative blood loss,blood transfusion,first postoperative walking time,post-operative thigh pain,clinical healing time,tip-apex distance（TAD） and Harris Hip Score（HHS） were recorded and compared.Results There was no significant difference between the two groups（P0.05）,and no case occurred infection and nonunion.The average operation time in PFNAⅡ group was shorter than that of PFNA group（P0.05）,and blood loss was less in PFNAⅡ group（P0.05）.The severity of post-operative thigh pain in PFNA group was eminently higher than that of PFNAⅡ group（P0.01）.HHS in PFNAⅡ group was higher than that of PFNA group one year later（P0.05）.There was no significant difference in other aspects such as blood transfusion,TAD and clinical healing（P0.05）.Conclusion Unstable femoral trochanteric fractures in elderly people could be treated either with PFNA or PFNAⅡsatisfactorily.However,PFNAⅡ is better for Asian people than PFNA,which is more convenient to perform operation and more effective to decrease the severity of post-operative thigh pain.