闭合与切开复位防旋型股骨近端髓内钉固定治疗老年股骨转子间骨折疗效比较

Treatment of aged intertrochanteric fractures with proximal femoral nail antirotation: a comparison of close reduction and open reduction

目的比较闭合复位与切开复位防旋型股骨近端髓内钉(PFNA)固定治疗老年股骨转子间骨折的疗效。方法对87例老年股骨转子间骨折患者行PFNA固定治疗,切开复位32例,闭合复位55例。比较两组的切口长度、手术时间、术中失血量、骨折复位、内固定满意率、患肢部分负重时间、骨折愈合时间、并发症及髋关节功能情况。结果切口长度、手术时间及术中失血量闭合复位组均明显短(少)于切开复位组(P<0.01),骨折复位满意率闭合复位组高于切开复位组(P<0.05)。87例均获随访,随访时间:闭合复位组12～42个月,切开复位组12～48个月。部分负重时间闭合复位组明显早于切开复位组(P<0.01)。并发症:切开复位组发生率为22%,闭合复位组无严重并发症(P<0.01)。两组骨折全部愈合,愈合时间差异无统计学意义(P>0.05)。末次随访时髋关节Harris评分闭合复位组高于切开复位组(P<0.01)。结论与切开复位PFNA固定比较,闭合复位PFNA固定治疗老年股骨转子间骨折手术操作简便,患者功能恢复更好。

Objective To compare the curative effect of proximal femoral nail antirotation （PFNA） by close reduction with that of PFNA by open reduction on aged intertrochanteric fractures. Methods Eighty-seven elderly patients with intertrochanteric fractures treated with PFNA （open reduction in 32 cases and close reduction in 55 ） were analyzed retrospectively. The wound Size, operation time, blood loss, satisfactory reduction, adequate screw position, part weight-bearing time, fracture healing time, complications, and functional outcomes were compared between 2 groups. Results The wound size, operation time and blood loss in the close group were significantly less than those in the open group （P 〈 0. 01 ）. When compared with the open reduction group, the rate of satisfactory reduction was significantly higher （ P 〈 0.05 ） in the close reduction group. All 87 patients were followed up, and the follow-up time was 12 -42 months in the close reduction group and 12 -48 months in the open reduction group. The part weightbearing time in the close reduction group was significantly earlier than that in the open reduction group（ P 〈 0. 01 ）. The complication rate was 22% in the open reduction group and there were not any serious complications in the close reduction group, showing significant difference （P 〈 0. 01 ）. All fractures were healed and no significant difference was found in fracture healing time between two groups （ P 〉 0.05 ）. At last follow-up, the Harris hip score was higher in the close reduction group than that in the open reduction group, showing significant difference （ P 〈 0. 01 ）. Conclusions When compared with open reduction, close reduction by orthopedic traction table with PFNA is an better method for treatment of aged intertrochanteric fractures because of simple operation and better functional recovery.