PFNA、APFLP及InterTan髓内钉治疗高龄不稳定性转子间骨折临床效果比较

Effect Comparison on Internal Fixation of PFNA,InterTan and APFLP for Unstable Intertrochanteric Fractures in Aged Patients

目的比较股骨近端防旋髓内钉(PFNA)、股骨近端解剖锁定钢板(APFLP)及联合拉力交锁髓内钉(Inter Tan)治疗高龄不稳定性转子间骨折的临床效果。方法 2009年4月~2015年4月我院收治高龄不稳定性转子间骨折患者90例,根据内固定方式的不同分为三组,各30例,分别采用PFNA、Inter Tan及APFLP内固定。比较三组患者术中出血量、手术时间、切口长度、术中透视次数、住院时间、骨折愈合时间、髋关节功能优良率、髋关节功能评分(Harris评分)及术后并发症情况。结果两组患者均获得1年以上随访。PFNA组患者术中出血量最小、手术时间最短,Inter Tan组次之,APFLP组术中出血最多、手术时间最长(P<0.05);PFNA组与Inter Tan组切口长度、术中透视次数均小(/少)于APFLP组(P<0.05)。三组患者住院时间、骨折愈合时间、髋关节功能优良率、Harris评分差异均无统计学意义(P>0.05);而APFLP组总并发症率明显高于其他两组(P<0.05),而PFNA组和Inter Tan组并发症率比较无统计学差异(P>0.05)。结论 PFNA、APFLP及Inter Tan髓内钉内固定均适用于高龄不稳定性转子间骨折,但PFNA具有手术操作简单、术中创伤较小、术后并发症较少等优点,成为不稳定性转子间骨折治疗的首选。

Objective To explore and compare the curative effect on the internal fixation of proximal femoral nail anti-rotation（PFNA）,Inter Tan and anatomic proximal femoral locking plate（APFLP） in the treatment of unstable intertrochanteric fractures in aged. Methods A total of 90 patients with unstable intertrochanteric fracture collected from April 2009 to April 2014 in our hospital were divided into three groups（n =30） according to internal fixation,and performed PFNA fixation（the PFNA group）,Inter Tan fixation（the Inter Tan group） and APFLP fixation（the APFLP group） respectively. The intraoperative blood loss,operation time,length of incision,intraoperative fluoroscopy times,the length of hospital stays,time of fracture healing,hip function outcome（Harris score）,fine rate and postoperative complications were recorded and compared among three groups. Results All cases of three groups were followed up more than one year. Among three groups,the PFNA group had least blood loss and shortest operative time,Inter Tan group followed,and APFLP group had most blood loss and longest operative time（P 0. 05）. The length of incision and intraoperative fluoroscopy times of both PFNA group and Inter Tan group were less than those of APFLP group（P 0. 05）. There was no statistical difference in the length of hospital stays,fracture healing time,Harris score and fine rate of hip function among three groups（P0.05）.The postoperative complication rate of APFLP group were higher than the other two groups（P0.05）,but there was no statistical difference between PFNA group and InterT an group（P0.05）.Conclusions All the internal fixation of PFNA,APFLP and InterT an were suitable for the unstable intertrochanteric fractures in aged.But PFNA was the first choice in consideration of the simple operation procedure,minimally intraoperative trauma and less postoperative complications.