改良股骨近端抗旋髓内钉置入对老年骨质疏松性股骨转子间骨折患者近期疗效的影响

Short-term effect of modified proximal femoral nailing antirotation intramedullary fixation for osteoporotic intertrochanteric fractures in elderly patients

目的探讨改良股骨近端抗旋髓内钉置入对老年骨质疏松性股骨转子间骨折患者近期疗效的影响。方法选取2014年6月—2015年12月河南省第二人民医院收治的84例老年骨质疏松性股骨转子间骨折患者,依据建档顺序分组,各42例。对照组采用传统股骨近端抗旋髓内钉术式,研究组采用改良股骨近端抗旋髓内钉术式,术后10个月随访。统计对比2组手术情况、髋关节功能优良率、并发症发生率,分析入院时及随访期间日常生活能力评分(BI评分)及髋关节功能评分(Harris评分)变化情况。结果研究组手术用时、术中失血量、下床活动时间、骨折愈合时间少于对照组(P<0.05)。术前2组BI评分及Harris评分比较差异无统计学意义(P>0.05),术后2组BI评分及Harris评分均较术前增高(P<0.05),且研究组BI评分及Harris评分高于对照组(P<0.05)。研究组髋关节功能优良率为92.86%(39/42),高于对照组的71.43%(30/42)(P<0.05)。研究组并发症发生率为9.52%(4/42),低于对照组的28.57%(12/42)(P<0.05)。结论采用改良股骨近端抗旋髓内钉置入术治疗老年骨质疏松性股骨转子间骨折效果显著,可减少手术用时、失血量及康复用时,改善髋关节功能及日常生活能力,且安全性较高。

Objective To explore the effect of modified proximal femoral nailing antirotation（PFNA） intramedullary fixa- tion for osteoporotie intertrochanteric fractures in elderly patients. Methods Eighty-four cases of senile osteoporotic inter- trochanteric fractures in our hospital between June,2014 and December,2014 were enrolled and assigned into study group and control group according to the document order, with 42 cases in each group. The control group was treated with con- ventional proximal femoral nailing antirotation intramedullary fixation, while the study group with modified proximal femo- ral nailing antirotation intramedullary fixation, and all patients were followed up for 10 months. The operation, hip func- tion,incidence of complications,the activities of daily living（ Barthel Index score） and hip function score（ Harris score） at admission and during the follow-up were compared between the two groups. Results The operation duration, intraopera- tive blood loss, time to postoperative ambulation, and time for fracture healing in the study group were less than those in the control group（ P 〈 O. 05 ）. There was no significant difference in BI score and Harris score between the two groups be- fore the surgery（ P 〉 0.05 ）. BI scores and Harris scores of both groups were higher than those before the operation （P 〈 0.05）, and the BI scores and Harris scores of the study group were higher than those of the control group（ P 〈 0.05 ）. The excellent and good rate of hip joint function in the study group was 92.86% （39/42） ,which was higher than that in the control group （ 71.43 %, 30/42 ）, P 〈 0.05. The incidence of complication in the study group was 9.52 % （ 4/42 ）, which was lower than that in the control group（ 28.57%, 12/42 ）, P 〈 0.05. Conclusion The effect of modified proximal femo- ral nailing antirotation intramedullary fixation for osteoporotic intertrochanteric fractures in elderly patients is significant,it can reduce the operation duration, blood loss and rehabilitation time, improve hip function and activities of daily living, with high security.