三种内固定方式治疗内侧壁缺损的不稳定型股骨转子间骨折的疗效比较

Comparison of fixations with dynamic hip screw, percutaneous compression plate and proximal femoral nail anti-rotation for intertrochanteric femoral fractures with paries medialis defect

目的 比较3种内固定方式治疗内侧壁缺损的不稳定型股骨转子间骨折的疗效. 方法 回顾性分析2011年1月至2016年7月期间采用内固定治疗的82例伴内侧壁缺损的股骨转子间骨折患者资料.男42例,女40例;平均年龄为73.0岁（27 ～91岁）.骨折AO分型：31-A2.2型72例,31-A2.3型10例.根据所采用内固定方式不同分为3组：动力髋螺钉（DHS）组9例,经皮加压钢板（PCCP）组17例,股骨近端防旋髓内钉（PFNA-Ⅱ）组56例.比较3组患者的术中出血量、围手术期输血量、术中输液量、手术时间、骨折愈合时间、并发症发生率及术后12个月髋部骨折功能恢复量表（FRS）评分等. 结果 PCCP组患者术中输液量[1 100（850,l 100） mL]和术中出血量[60（5,100） mL]显著少于PFNA-Ⅱ组患者[1 100（1 000,1700）、150（50,300） mL],手术时间[（91.4±29.2） min]显著短于PFNA-Ⅱ组患者[（140.7±62.7）min],差异均有统计学意义（P＜0.05）;而3组患者之间的围手术期输血量比较差异无统计学意义（P＞0.05）.57例患者术后获平均47个月（15 ～85个月）随访,DHS组8例,PCCP组12例,PFNA-Ⅱ组37例.3组患者的骨折愈合时间、并发症发生率及术后12个月FRS评分比较差异均无统计学意义（P＞0.05）. 结论 对于伴有内侧壁缺损的不稳定型股骨转子间骨折,目前尚不能确定髓内固定比髓外固定更有优势.对于术前活动功能和一般情况较好的患者推荐髓内固定治疗,如PFNA-Ⅱ固定;一般条件差的患者推荐选择髓外固定治疗,如PCCP固定.

Objective To compare the effects of fixations with dynamic hip screw （DHS）,percutaneous compression plate （PCCP） and proximal femoral nail anti-rotation （PFNA） for treatment of intertrochanteric femoral fractures with paries medialis defect.Methods We reviewed the 82 patients with femoral intertrochanteric fracture and paries medialis defect who had been treated at our department from January 2011 to July 2016.They were 42 men and 40 women,aged from 27 to 91 years （average,73.0 years）.According to the AO classification,72 cases belonged to type 31-A2.2,10 to type 31-A2.3.Of them,9 cases were treated with DHS,17 cases with PCCP and 56 cases with PFNA-1].The 3 groups were compared in terms of intraoperative blood loss,blood infusion,fluid infusion,operation duration,time for fracture union,postoperative complications and Functional Recovery Score （FRS） of the hip 12 months after operation.Results The fluid infusion [1,100 （850,1,100） mL] and intraoperative blood loss [60 （5,100） mL] in the PCCP group were significantly less than in the PFNA group [1,100 （1,000,1,700） mL and 150 （50,300） mL] and the operation duration （91.4 ± 29.2 min） in the former was significantly shorter than in the latter [121 （85,185） min] （P ＜ 0.05）.No significant difference was found between the 3 groups in blood infusion （P ＞ 0.05）.Of the patients,57 （8 DHS,12 PCCP and 37 PFNA ones） were followed up for an average of 47 months （from 15 to 85 months）.There were no statistically significant differences between the 3 groups in time for fracture union,complications,or average FRS score of the hip 12 months after operation （P ＞ 0.05）.Conclusions For unstable intertrochanteric fractures with paries medialis defect,it is not clear that intramedullary nails are superior to extramedullary fixation.Intramedullary nails like PFNA may be suggested for patients with better preoperative conditions while extramedullary fixation like PCCP suggested for those with poor general conditions.