微创孟氏架外固定治疗老年股骨顺转子间骨折的临床研究

A clinical study of minimally invasive external fixation with Meng's fixator for treatment of femoral antegrade intertrochanteric fractures in the aged

目的：观察微创孟氏架外固定治疗老年股骨顺转子间骨折的临床疗效及安全性。方法：回顾性分析205例老年股骨顺转子间骨折患者的病例资料,其中采用微创孟氏架外固定96例,采用股骨近端防旋髓内钉（proximal femoral nail antirotation,PFNA）固定109例。男98例,女107例。年龄63~99岁,中位数76岁。按照股骨转子间骨折的Evans分型,Ⅰa型20例、Ⅰb型43例、Ⅰc型86例、Ⅰd型56例。受伤至手术时间3~7 d,中位数4 d。比较2组患者的手术时间、术中出血量、骨折愈合时间、术后开始部分负重行走时间及并发症发生率,比较2组术后3个月采用Harris髋关节功能评分标准评定的临床疗效。结果：所有患者均获随访,随访时间12~24个月,中位数16个月。孟氏架组的手术时间、骨折愈合时间及术后开始部分负重行走时间均短于PFNA组[（33.09±3.18）min,（52.23±6.99）min,t=-12.370,P=0.000;（12.00±0.80）周,（16.30±1.30）周,t=-12.524,P=0.000;（13.40±1.10）d,（27.80±1.10）d,t=-12.546,P=0.000],其术中出血量小于PFNA组[（11.10±2.20）m L,（100.30±12.20）m L,t=-12.390,P=0.000]。术后孟氏架组出现2例针孔感染、2例下肢深静脉血栓形成、4例固定物松动、3例髋内翻,PFNA组出现1例切口感染、2例下肢深静脉血栓形成、2例内固定物松动、1例髋内翻,2组患者并发症发生率比较,差异无统计学意义（χ2=2.379,P=0.099）。孟氏架组优71例、良15例、差10例,PFNA组优80例、良20例、差9例,2组患者的临床疗效比较,差异无统计学意义（Z=0.473,P=0.789）。结论：孟氏架外固定治疗老年股骨顺转子间骨折,疗效及安全性与PFNA内固定相当,但其具有手术时间短、术中出血少、骨折愈合快、患者可早期行走等优点,值得临床推广应用。

Objective： To observe the clinical curative effect and safety of minimally invasive external fixation with Meng＇s fixator in treatment of femoral antegrade intertrochanteric fractures in the aged. Methods： The medical records of 205 aged patients with femoral antegrade intertrochanteric fractures were analyzed retrospectively. Ninety-six patients were treated with minimally invasive external fixation with Meng＇s fixator（ Meng＇s fixator group）,while the others were treated with proximal femoral nail antirotation（ PFNA group）. The patients consisted of 98 males and 107 females,and ranged in age from 63 to 99 years（ Median = 76 yrs） and ranged in disease course from 3 to 7days（ Median = 4 days）. According to the Evans classification of intertrochanteric fractures,the fractures belonged to types Ia（ 20）,Ib（ 43）,Ic（ 86） and Id（ 56）. The operative time,blood loss,fracture healing time,postoperative partial weight-bearing walk start time and complication incidences were compared between the 2 groups. The clinical curative effect were evaluated according to Harris hip function scoring standard and were compared between the 2 groups at 3 months after the surgery. Results： All patients in the 2 groups were followed up for12- 24 months with a median of 16 months. The operative time,fracture healing time and postoperative partial weight- bearing walk start time were shorter in Meng＇s fixator group compared to PFNA group（ 33. 09 ＋ /- 3. 18 vs 52. 23 ＋ /- 6. 99 min,t =- 12. 370,P = 0. 000;12. 00 ＋ /- 0. 80 vs 16. 30 ＋ /- 1. 30 weeks,t =- 12. 524,P = 0. 000; 13. 40 ＋ /- 1. 10 vs 27. 80 ＋ /- 1. 10 days,t =- 12. 546,P = 0. 000）,while the blood loss was less in Meng＇s fixator group compared to PFNA group（ 11. 10 ＋ /- 2. 20 vs 100. 30 ＋ /- 12. 20 ml,t =- 12. 390,P = 0. 000）. After the surgery,pin hole infection（ 2）,lower extremity deep venous thrombosis（ 2）,loosening of internal fixator（ 4） and coxa vara（ 3） were found in Meng＇s fixator group; while incision infection（ 1）,lower extremity deep venous thrombosis（ 2）,loosening of internal fixator（ 2） and coxa vara（ 1） were found in PFNA group. There was no statistical difference in complication incidences between the two groups（ χ2= 2. 379,P = 0. 099）. Seventy- one patients obtained an excellent result,15 good and 10 poor in Meng＇s fixator group; while 80 patients obtained an excellent result,20 good and 9 poor in PFNA group. There was no statistical difference in clinical curative effects between the 2 groups（ Z = 0. 473,P = 0. 789）. Conclusion： External fixation with Meng＇s fixator is similar to PFNA internal fixation in the total curative effect and safety in treatment of femoral antegrade intertrochanteric fractures in the aged,while the former has the advantages of shorter operative time,less blood loss,faster fracture healing and earlier ambulation,so it is worthy of popularizing in clinic.