股骨近端防旋髓内钉治疗股骨转子下骨折疗效分析

Proximal femoral nail anti-rotation in treatment of subtrochanteric fracture

目的探讨股骨近端防旋髓内钉（PFNA）内固定治疗股骨转子下骨折（SFF）的应用及疗效。方法收集并分析2014年2月至2016年2月佛山市三水区人民医院骨科采用PFNA或股骨近端锁定钢板固定（LPFP）方法治疗58例SFF患者的临床资料,按治疗方法分为PFNA组治疗组和LPFP治疗组,其中PFNA组男性25例,女性11例,平均年龄（48±14）岁;LPFP组男性17例,女性5例,平均年龄（43±12）岁。术后随访时间为4-16个月,平均（10±3）个月。记录PFNA组与LPFP组患者的切口长度、手术时间、手术出血量、术后引流量、下床活动时间、骨折愈合时间、术后并发症及末次随访Harris髋关节功能评分（Harris评分）。其中两组的切口长度、手术时间、手术出血量、术后引流量、下床活动时间、骨折愈合时间采用独立样本t检验;两组的术后并发症及末次随访Harris评分采用χ^2检验进行比较。结果本研究所有患者均能坚持随访。PFNA组患者与LPFP组患者在手术时间（t=-0.586,P〉0.05）及手术出血量（t=-0.568,P〉0.05）指标相似,两组比较差异无统计学意义;但在切口长度（t=-4.699,P〈0.01）、术后引流量（t=-7.117,P〈0.01）、下床活动时间（t=-3.360,P〈0.01）及骨折愈合时间（t=-4.97,P〈0.01）方面,PFNA组患者均优于LPFP组,两组比较差异均有统计学意义;在末次随访的Harris评分（χ^2=6.475,P〈0.05）和并发症总发生率（χ^2=8.529,P〈0.05）中,PFNA组患者明显优于LPFP组,两者比较差异有统计学意义。结论PFNA方法治疗SFF操作简单,术后并发症少,更符合股骨近端生物力学的要求,疗效明显,有利于恢复肢体功能,值得推广。

Objective To explore the clinical outcome of femoral subtrochanteric fracture treated with proximal femoral nail anti-rotation（ PFNA）. Methods Fifty-eight patients diagnosed as femoral subtrochanteric fracture in the department of orthopedics,People ＇s Hospital of Sanshui District from February 2014 to February 2016 were retrospectively reviewed. The patients were divided into two groups based on internal fixation device： proximal femoral nail anti-rotation group（ PFNA group） and the locking proximal femoral plate group（ LPFP group）. The PFNA group included 25 males and 11 females,with an average age of（ 48 ± 14） years; the LPFP group included 17 males and five females,with an average age of（ 43 ± 12） years. The average follow-up period was（ 10 ± 3） months,ranging from four to 16 months.The incision length,operation time,blood loss volume,drainage volume,postoperative weight-bearing time,bone healing time,complications and Harris hip score at the final follow-up were compared. The incision length,operation time,blood loss volume,drainage volume,postoperative weight-bearing time and bone healing time were compared by independent sample t test; the complications and Harris hip score at the final follow-up were compared by chi-square test. Results All the patients were followed up. No significant difference was found in operation time（ t =- 0. 586,P〉0. 05） and blood loss volume（ t =- 0. 568,P〉0. 05） between the two groups. The statistical differences were found in the incision length（ t =- 4. 699,P〈0. 01）,blood drainage volume（ t =- 7. 117,P〈0. 01）,bone healing time（ t =- 3. 360,P〈0. 01） and postoperative weight-bearing time（ t =- 4. 97,P〈0. 01） between the two groups. The Harris hip score（ χ^2= 6. 475,P〈0. 05） was significantly higher and the overall complication rate（ χ^2= 8. 529,P〈0. 05） was lower in the PFNA group than the LPFP group. Conclusion PFNA has achieved satisfactory outcomes when treating femoral subtrochanteric fracture with easier procedure,lower complication rate and better biomechanics,and is worthwhile to be promoted.