长、短股骨近端防旋髓内钉固定股骨转子间骨折的对比

Long versus short proximal femoral nail antirotation in treatment of intertrochanteric fractures

背景:短钉与长钉股骨近端防旋型髓内钉内固定治疗股骨转子间骨折的临床对比研究尚缺少相关报道。目的:对比分析AO/ASIF-A1/2型股骨转子间骨折采用长钉与短钉股骨近端防旋型髓内钉固定治疗的临床效果。方法:选择股骨近端防旋型髓内钉治疗的AO/ASIF-A1/2型股骨转子间骨折患者98例。根据患者应用的股骨近端防旋型髓内钉类型,将病例分两组,短钉组50例,长钉组48例。记录两组的手术时间、术中出血量以及住院时间等围手术期数据。在随访中,对患者的骨折愈合、影像学及临床并发症等情况进行评估;在末次随访时,采用Harris髋关节评分评价患者的功能恢复情况。结果与结论:与短钉组比较,长钉组手术时间更长,术中出血量更多(P<0.05);但两组的住院时间比较差异无显著性意义(P>0.05)。长钉组与短钉组的平均随访时间分别为(15.8±6.4)个月和(16.2±5.7)个月。患者因螺旋刀片切出或感染而再次实施手术的患者长钉组中有5例,短钉组中有3例,除上述再手术患者之外,两组其余所有患者至末次随访时骨折均获得愈合,平均骨折愈合时间组间差异无显著性意义(P=0.588)。在末次随访时,两组的平均Harris髋关节评分差异无显著性意义(P=0.204)。长钉组与短钉组的总体并发症发生率分别为31.2%和16.0%,组间差异无显著性意义(P=0.075)。结果可见长钉与短钉股骨近端防旋型髓内钉固定治疗AO/ASIF-A1/A2型股骨转子间骨折在骨折愈合率及并发症发生率上无显著差别,相比短钉固定,长钉固定治疗AO/ASIF-A1/A2型股骨转子间骨折并无临床优势。

BACKGROUND： There are few clinical controlled trials about the clinical effects in patients with pertrochanteric femur fractures after treatment with short or long proximal femoral nail antirotation. OBJECTIVE： To compare the clinical outcomes in patients with AO/ASIF-A1/2 pertrochanteric femur fractures after treatment with short or long proximal femoral nail antirotation. METHODS： A total of 98 patients with AO/ASIF-A1/2 pertrochanteric femur fractures were treated by proximal femoral nail antirotation. They were divided into two groups according to the type of proximal femoral nail antirotation： short nail group （n=50） and long nail group （n=48）. The operative time, blood loss, and hospital stay were recorded in both groups. In follow-up, fracture healing time, imaging and clinical complications were evaluated. In the final follow-up, Harris hip score was used to evaluate functional recovery. RESULTS AND CONCLUSION： Compared with the short nail group, operative time was shorter and blood loss was less in the long nail group （P 〈 0.05）. No significant difference in hospital stay was detected between the short nail and long nail groups （P 〉 0.05）. Average follow-up periods were respectively （15.8±6.4） months and （16.2±5.7） months in the long nail and short nail groups. ＂Cutting-out＂ or infection occurred in five patients in the long nail group and three in the short nail group. Besides above-mentioned patients, the remaining patients in the two groups achieved fracture healing. No significant difference in average fracture healing time was detected between groups （P=0.588）. In the final follow-up, no significant difference in Harris hip score was detectable in the two groups （P=0.204）. The incidence rates of total postoperative complications in the long and short nail groups were 31.2% and 16.0%, respectively （P=0.075）. Results suggested that no differences in the union and complication rates between the two groups were identified, suggesting that long nails offer no advantage compared with short nails for stabilizing AO/ASIF-A1/A2 pertrochanteric femur fractures.