复位股骨大粗隆顶点骨折对PFNA治疗不稳定股骨粗隆间骨折预后的影响

Effect of top of great trochanter fracture replacement in treatment unstable femoral intertrochanteric fracture with proximal femoral nail antirotation

目的评估应用股骨近端防旋髓内钉(PFNA)内固定治疗合并股骨大粗隆顶点局部骨折的不稳定股骨粗隆间骨折术中将股骨大粗隆顶点局部骨折复位对预后的影响。方法合并股骨大粗隆顶点局部骨折的不稳定股骨粗隆间骨折46例,股骨大粗隆顶点局部骨折复位固定26例(复位组),未复位固定20例(未复位组)。比较2组手术时间、术中出血量、术后第2天血红蛋白及白蛋白水平、骨折愈合时间、术后并发症及末次随访时髋关节功能Harris评分。结果复位组较未复位组手术时间更长、术中出血量更多,差异有统计学意义(P<0.05);但复位组在术后并发症及末次随访时髋关节的功能恢复方面明显优于未复位组,差异有统计学意义(P<0.05);而2组在骨折愈合时间、术后第2天血红蛋白及白蛋白水平方面差异无统计学意义(P>0.05)。结论复位固定移位的股骨大粗隆顶点骨折能够提高PFNA主钉进针定位的准确性,降低股骨大粗隆外侧壁继发性骨折的发生率,改善术后髋关节功能,减少术后隐性出血量。

Objective To assess the clinical effect of top of great trochanter fracture replacement in treatment unstable femoral intertrochanteric fracture with proximal femoral nail anti-retation （PFNA）. Methods Forty six patients with unstable femoral intertrochanteric fracture and dislocated great trochanter fracture were treated by PFNA, then randomly divided into two groups, with the top of great trochanter fracture replacement in operation for 26 cases （restoration group）, and without re- placement in operation for 20 cases （no restoration group）. The operative time, blood loss in operation, the level of hemoglobin and albumin at the 2nd day postoperation, fracture healing time, the rate of infection complication and hip function of the last follow-up were analyzed between two group. Results Compared with the no restoration group, the restoration group prolonged operation time, increased blood loss, while, reduced the lateral wall of secondary fracture, improved postoperative hip function （P 〈0.05）. There were no significant differences in the level of hemoglobin and albumin at the 2nd day postoperation and frac- ture healing time between two groups（P 〉0.05）. Conclusion The fixation of displaced fracture of the greater trochanter vertex can improve nail needle positioning accuracy, reduce the incidence of secondary lateral wall fractures of femoral greater trechanter, improve hip function and reduce postoperative hidden bleeding.