股骨近端防旋髓内钉螺旋刀片位置对老年股骨转子间骨折疗效的影响

Impact of helical blade positions on therapy effects of elderly femoral intertrochanteric fractures treated with proximal femoral nail antirotation

目的探讨股骨近端防旋髓内钉(PFNA)螺旋刀片位置对老年股骨转子间骨折治疗效果的影响。方法对92例接受PFNA治疗的老年股骨转子间骨折患者按螺旋刀片在股骨头的放置位置不同分为:C/C组(44例,螺旋刀片正位及侧位均处于股骨头中心位置)和I/C组(48例,螺旋刀片正位处于股骨头下1/3位置、侧位处于股骨头中心位置)。比较两组患者术后的骨折复位情况、术后完全负重时间、螺旋刀片的尖顶距(TAD)、骨折愈合时间、术后并发症及末次随访时髋关节Harris评分。结果两组患者的术后复位情况、完全负重时间、骨折愈合时间、术后并发症发生情况、术后各时点髋关节Harris评分比较差异均无统计学意义(P>0.05)。术后TAD:C/C组为(22.07±2.84)mm,I/C组为(25.29±3.41)mm,两组比较差异有统计学意义(P<0.05)。结论 PFNA两种螺旋刀片的安置位置治疗老年股骨转子间骨折患者均可取得良好效果,但两组的TAD有明显差异。

Objective To investigate the impact of helical blade positions on therapy effects of elderly femoral intertrochanteric fractures treated with proximal femoral nail antirotation（ PFNA）. Methods 92 elderly femoral intertrochanteric fractures receiving PFNA retrospectively were analyzed. All patients were divided into C / C group（44 cases）,the helical blade of which were at the center of the femoral head in both anteroposterior and lateral views,and I / C group（48 cases）,the helical blade of which was at the inferior one third of the femoral head in anteroposterior view and at the center in lateral view. The above two groups were compared in terms of fracture healing and recovery,full weight bearing time,tip-apex distance（ TAD）,fracture healing time,postoperation complication occurrence,and Harris Hip Score（ HHS） at the follow-up 6 months after operation. Results There were no significant differences between those two groups regarding fracture healing and recovery,full weight bearing time,TAD,fracture healing time,postoperation complication occurrence,and HHS at the follow-up 6 months after operation（ P〉0. 05）. The average TAD after operation was（22. 07 ± 2. 84） mm in C / C group and（25. 29 ± 3. 41） mm in I / C group,and the difference was significant（ P〈0. 05）. Conclusions The above two helical blade positions can achieve similar effects for elderly femoral intertrochanteric fractures with PFNA,but the TAD are different between two groups.