经皮加压钢板与股骨近端防旋髓内钉内固定治疗老年稳定性股骨转子间骨折:术后功能恢复、股骨头旋转及固定钉滑脱的比较

Effects of percutaneous compression plate versus proximal femoral nail anti-rotation internal fixation on the postoperative functional recovery and femoral head rotation and nail slippage in elderly patients with stable intertrochanteric fracture

背景:临床中若老年股骨转子间骨折患者出现不稳定性股骨转子间骨折则优先考虑髓内钉治疗;但患者为稳定性股骨转子间骨折时,髓外固定或髓内固定均可起到较好的修复效果,因而临床中如何选取内固定方案仍存在较大争议。目的:探讨经皮加压钢板与股骨近端防旋髓内钉内固定对老年稳定性股骨转子间骨折患者术后功能恢复的影响及患者术后股骨头旋转、固定钉滑脱情况,为临床选择提供依据。方法:将86例老年稳定性股骨转子间骨折患者随机分为2组,经皮加压钢板组患者进行经皮加压钢板内固定治疗,股骨近端防旋髓内钉组进行股骨近端防旋髓内钉内固定治疗。记录手术时间、术中出血量、术后血红蛋白下降量、患者下地负重时间及骨折愈合时间,并在术后4周时使用Harris评分系统对患者功能恢复情况进行评估,此外对患者术后4周时股骨头旋转率、固定钉滑脱量和术后6个月内出现的并发症进行统计。结果与结论:(1)股骨近端防旋髓内钉组患者术中出血量及术后血红蛋白下降量均显著高于经皮加压钢板组(P<0.05);(2)2组患者术后4周时Harris评分差异无显著性意义(P>0.05);股骨近端防旋髓内钉组下地负重时间、骨折愈合时间均显著短于经皮加压钢板组(P<0.05);(3)术后4周时经皮加压钢板组患者股骨头旋转率及固定钉滑脱量均显著高于股骨近端防旋髓内钉组(P<0.05);(4)2组患者术后6个月内的并发症发生率差异无显著性意义(P>0.05);(5)结果表明,经皮加压钢板和股骨近端防旋髓内钉内固定修复老年稳定性股骨转子间骨折时,患者术后功能恢复及术后并发症无明显差异;但在患者股骨头旋转率和固定钉滑脱量方面股骨近端防旋髓内钉更具优势。

BACKGROUND： Senile unstable intertrochanteric fractures are usually treated with intramedullary nail fixation, but forstable intertrochanteric fractures, extramedullary fixation and intramedullary nail both can obtain satisfactory curativeefficacy. Therefore, surgical options are still a controversy.OBJECTIVE： To investigate the effect of percutaneous compression plate （PCCP） versus proximal femoral nailanti-rotation （PFNA） on the postoperative functional recovery of the elderly with stable intertrochanteric fractures and toobserve the rotational stability and nail slipping.METHODS： Totally 86 elderly patients with stable intertrochanteric fracture were randomly divided into two groups, andthen underwent PCCP or PFNA. The operation time, intraoperative blood loss, postoperative hemoglobin level, the timeof weigh bearing, and fracture healing time were recorded; Harris hip scores at postoperative 4 weeks were detected toassess the functional recovery; the rotation rate of femoral head and incidence of nail slipping at 4 weeks postoperatively,as well as the complications within 6 months postoperatively were analyzed statistically.RESULTS AND CONCLUSION： （1） The intraoperative and postoperative declined levels of hemoglobin in the PFNAgroup were significantly higher than those in the PCCP group （P 〈 0.05）. （2） There was no significant difference for in theHarris hip scores between two groups at postoperative 4 weeks （P 〉 0.05）. The weight bearing time and fracture healingtime in the PFNA group were significantly shorter than those in the PCCP group （P 〈 0.05）. （3） The rotation rate offemoral head and nail slipping in the PFNA group were significantly lower than those in the PCCP group （P 〈 0.05）. （4）The incidence of complications within 6 months postoperatively did not differ significantly between two groups （P 〉 0.05）.（5） These results suggest that there is no significant difference in the postoperative function recovery and complicationsbetween PCCP and PFNA in the treatment of senile femoral intertrochanteric fracture fixation. However, PFNApossesses advantages in the rotation rate of femoral head and nail slipping.