髓内固定系统治疗老年股骨转子间骨折

Intramedullary fixation system in the treatment of elderly femoral intertrochanteric fractures

目的分析髓内固定系统对老年股骨转子间骨折的疗效。方法采用股骨近端抗旋髓内钉(PFNA)、股骨近端髓内钉(PFN)、联合加压交锁髓内钉(Inter Tan)及亚洲型股骨近端抗旋髓内钉(PFNA-Ⅱ)4种髓内固定系统治疗95例老年股骨转子间骨折患者。比较4种方法的手术时间、术中出血量、透视次数、骨折愈合时间及末次随访Harris评分。结果 95例均获得随访,时间7~20个月。骨折愈合时间6~9个月。PFNA组1例术后5个月发生外伤后股骨颈骨折;PFNA-Ⅱ组1例术后3个月发生螺旋刀片切出;PFN组2例术后1周时发生深静脉血栓。手术时间:PFN组长于其他3组,与PFNA组、PFNA-Ⅱ组比较差异有统计学意义(P<0.05),与Inter Tan组比较差异无统计学意义(P>0.05);Inter Tan组与PFNA组、PFNA-Ⅱ组比较差异有统计学意义(P<0.05);PFNA组与PFNA-Ⅱ组比较差异有统计学意义(P<0.05)。术中出血量:PFN组多于其他3组,与PFNA组、PFNA-Ⅱ组比较差异有统计学意义(P<0.05),与Inter Tan组比较差异无统计学意义(P>0.05);Inter Tan组与PFNA组、PFNA-Ⅱ组比较差异有统计学意义(P<0.05);PFNA组与PFNA-Ⅱ组比较差异无统计学意义(P>0.05)。C臂机透视次数:PFN组多于其他3组,与PFNA组、PFNA-Ⅱ组比较差异有统计学意义(P<0.05),与Inter Tan组比较差异无统计学意义(P>0.05);Inter Tan组与PFNA组、PFNA-Ⅱ组比较差异有统计学意义(P<0.05);PFNA组与PFNA-Ⅱ组比较差异无统计学意义(P>0.05)。4组骨折愈合时间和末次随访Harris评分比较差异无统计学意义(P>0.05)。结论股骨转子间骨折选择合适的髓内固定系统治疗都可以获得良好疗效,而PFNA-Ⅱ和PFNA损伤更小。

Objective To analyze the effect of intramedullary fixation system on femoral intertrochanterie fracture in the elderly. Methods Proximal femoral nail anti-rotation （PFNA） , proximal femoral nail （PFN） , pressure interlocking intramedullary nail （InterTan） and Asian PFNA（ PFNA-]I ） four intramedullary fixation system were used to treat 95 elderly patients with femoral fractures. The operation time, intraoperative blood volume, number of fluorosco- py, fracture healing time and the final follow-up of Harris scores were compared among four methods. Results All 95 cases were followed up for 7 - 20 months. Fracture healing time was 6 - 9 months. The femoral neck fracture oc- curred in 1 case of PFNA group at 5 months after the operation. 1 case of postoperative 3 months spiral blade cut out in PFNA- Ⅱ group ; deep venous thrombosis occurred in 2 cases of the PFN group at 1 week after operation. Operation time ： PFN group was longer than other three groups, compared with PFNA group and PFNA- Ⅱ group, the difference was statistically significant （ P 〈 0. 05）, there was no statistically significant difference compared with InterTan group （P 〉 0. 05 ） ; InterTan group was compared with PFNA group and PFNA- Ⅱ group, the differences were statistically significant （P 〈 0. 05 ）. PFNA group was compared with PFNA - Ⅱ group, the difference was statistically significant （ P 〈 0. 05 ）. Intraoperative blood loss ： PFN group was more than the other three groups, compared with PFNA group and PFNA-Ⅱ group, the differences were statistically significant （P 〈 0. 05 ）, there was no statistically significant difference compared with InterTan group （ P 〉 0. 05 ） ; InterTan group was compared with PFNA group and PFNA- Ⅱ group, the differences were statistically significant （ P 〈0. 05 ） , PFNA group had no statistically significant difference compared with PFNA- Ⅱ group （P 〉 0. 05 ）. Machine C-arm fluoroscopy times ： PFN group was more than the other three groups, compared with PFNA group and PFNA-Ⅱ group, the differences were statistically significant （P 〈 0. 05 ）, there was no statistically significant difference compared with InterTan group （ P 〉 0. 05 ） ; InterTan group was compared with PFNA group and PFNA- Ⅱ group, the differences were statistically significant （ P 〈 0. 05 ） ; PFNA group had no statistically significant difference compared with PFNA- Ⅱ group （P 〉 0. 05 ）. There were not statistical- ly significant difference among the four groups of fracture healing time and the last follow-up of Harris scores （ P 〉 0. 05）. Conclusions Femoral intertrochanteric fractures should be treated with proper methods as intramedullary fixation system which can obtain good curative effect, and PFNA-Ⅱ and PFNA are less trauma.