老年股骨粗隆间骨折股骨近端抗旋髓内钉和股骨近端髓内钉InterTAN的选择和疗效评价

CHOICE AND EFFECTIVENESS EVALUATION OF PROXIMAL FEMORAL NAIL ANTIROTATION AND InterTAN IN TREATMENT OF ELDERLY INTERTROCHANTERIC FRACTURES

目的分析比较股骨近端抗旋髓内钉（proximal femoral nail antirotation,PFNA）和股骨近端髓内钉Inter TAN治疗老年股骨粗隆间骨折的临床效果和手术并发症。方法 2011年1月-2013年6月共178例患者符合选择标准纳入研究,根据手术所选髓内钉的不同分为PFNA组（100例）和Inter TAN组（78例）。两组患者性别、年龄、侧别、致伤原因、骨折分型及伤后至手术时间等一般资料比较差异无统计学意义（P〉0.05）,具有可比性。记录两组患者的手术时间、术中出血量、术中透视时间、术后并发症发生情况、住院时间、骨折愈合时间并进行比较;术后采用Harris评分评价关节功能。结果 PFNA组手术时间、术中出血量及术中透视时间均明显少于Inter TAN组（P〈0.05）;两组住院时间比较差异无统计学意义（t=1.270,P=0.206）。两组各有2例切口出现红肿,经清创后愈合;其余患者术后切口均Ⅰ期愈合,无皮肤坏死等并发症发生。术后PFNA组92例、Inter TAN组63例患者获随访,随访时间8~16个月,平均11个月;失访患者中PFNA组4例死亡,Inter TAN组3例死亡,其余患者失联。PFNA组（含4例死亡患者）中出现下肢深静脉血栓形成2例、髋内翻2例,并发症发生率4.2%;Inter TAN组（含3例死亡患者）中出现下肢深静脉血栓形成1例、髋内翻2例,并发症发生率4.5%;两组比较差异无统计学意义（χ2=0.077,P=0.782）。术后X线片示骨折线消失,均未出现畸形愈合、骨不连、感染、内固定物松弛失效等并发症,患者可正常行走;两组患者骨折愈合时间比较差异无统计学意义（t=1.324,P=0.188）。末次随访时,两组Harris评分比较差异无统计学意义（t=1.594,P=0.113）。结论 PFNA是治疗伴骨质疏松的老年股骨粗隆间骨折理想的治疗方法;Inter TAN更适用于较年轻及不稳定股骨粗隆间骨折患者。

Objective To compare the effectiveness and complications of proximal femoral nail antirotation（PFNA） and Inter TAN nail in treatment of elderly intertrochanteric fractures.Methods A total of 178 patients with intertrochanteric fractures between January 2011 and June 2013 were enrolled.PFNA was used in 100 cases（PFNA group） and Inter TAN in 78 cases（Inter TAN group）.No significant difference was found in gender,age,side of fracture,cause of injury,fracture classification,and time between injury and operation between 2 groups（P〉0.05）.The operation time,intraoperative blood loss,intraoperative fluoroscopy time,postoperative complications,hospitalization time,fracture healing time,and Harris score were compared between 2 groups to evaluate the effectiveness.Results The operation time,intraoperative blood loss,intraoperative fluoroscopy time in PFNA group were significantly less than those in Inter TAN group（P〈0.05）.The hospitalization time had no significant difference between the 2 groups（t=1.270,P=0.206）.Primary healing was obtained in the others except 2 cases having red and swollen in each group respectively.Ninety-two cases of PFNA group and 63 cases of Inter TAN group were followed up 11 months on average（range,8-16 months）.In the patients who were lost,there were 4 deaths in PFNA group and 3 deaths in Inter TAN group.The complication rate was 4.2% in PFNA group（2 cases of deep venous thrombosis and 2 cases of hip varus） and was 4.5% in Inter TAN group（1 case of deep venous thrombosis and 2 cases of hip varus）,showing no significant difference between 2 groups（χ2=0.077,P=0.782）.X-ray showed that the fracture line disappeared;no complications of malunion,bone nonunion,infection,and loosening of internal fixation occurred.The patients could walk normally.The healing time and Harris hip scores at last follow-up showed no significant difference between 2 groups（t=1.324,P=0.188;t=1.594,P=0.113）.Conclusion PFNA is suitable for elderly patients with osteoporosis in treatment of femoral intertrochanteric fracture;Inter TAN can be a better choice for younger patients or patients with unstable fracture.