摘要
目的比较InterTAN钉和股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)治疗老年骨质疏松患者AO/OTA 31-A2型股骨转子间骨折的临床疗效。方法回顾性分析我院从2014年2月至2016年4月收治的老年(≥60岁)骨质疏松AO/OTA 31-A2型股骨转子间骨折患者196例,其中男72例,女124例,患者年龄为60~88岁,平均72.1岁。致伤原因:跌倒损伤142例,车祸伤54例。骨折分型:A2.1型32例,A2.2型73例,A2.3型91例。按照手术方法分为两组,InterTAN组(86例)和PFNA组(110例)。结果本组均获14~38个月随访,平均32.4个月。PFNA组术后假体周围骨折的发生概率(2.3%)低于InterTAN组(8.2%),两组相比差异无统计学意义(P=0.071),InterTAN组未见近端螺钉切出,而PFNA组发生3例近端螺钉切出,予以翻修处理;PFNA组术后1例出现髋内翻畸形,行翻修手术。两组的失败发生率相比,InterTAN组明显优于PFNA组,差异有统计学意义(P=0.015);两组的手术时间、术中透视时间以及术中失血量比较差异无统计学意义(P=0.431,0.271,0.623);两组术后Harris功能评分比较,差异无统计学意义(P>0.05)。结论 InterTAN相比于PFNA内固定,治疗老年骨质疏松AO/OTA 31-A2型股骨转子间骨折并发症发生率低,治疗效果显著,值得临床推广。
Objective To compare the functional and radiographic outcomes of InterTAN intramedullary nail ( IT ) and proximal femoral nail anti-rotation ( PFNA ) in the treatment of primary AO / OTA 31-A2 intertrochanteric hip fracture in older patients with osteoporosis. Methods From February 2014 to April 2016, 196 patients ( ≥ 60 years, 72 males, 124 females ) diagnosed as primary AO / OTA 31-A2 intertrochanteric hip fracture received IT or PFNA internal fixation. The mean age was 72.1 years ( range: 60 - 88 years ). Causes of injury: 142 cases of falls and 54 cases of car accidents. Fracture classification: 32 cases of A2.1 type, 73 cases of A2.2 type, 91 cases of A2.3 type. According to the surgical method, all patients were divided into InterTAN group ( 86 cases ) and PFNA group ( 110 cases ). Results The mean follow-up was 32.4 months ( range: 14 - 38 months ). The occurrence of postoperative periprosthetic fracture was significantly lower in the IT group than in the PFNA group ( 2.3% vs. 8.2% ) ( P = 0.071 ). No proximal screw move was observed in the InterTAN group, while 3 were observed in the PFNA group. In the PFNA group, 1 case of hip varus deformity was observed and revision surgery was performed. The failure incidence was significantly lower in the InterTAN group than that in the PFNA group (P = 0.015 ). There were no significant differences in the operation time, intraoperative fluoroscopy time, intraoperative blood loss ( P = 0.431, 0.271, 0.623 ), and Harris functional score between the 2 groups ( P 〉 0.05 ). Conclusions Regarding the treatment of primary AO / OTA 31-A2 intertrochanteric hip fracture in older osteoporotic patients, IT internal fixation could achieve better clinical outcomes compared with PFNA fixation.
作者
袁琦
李强
郝彦明
吴晗
YUAN Qi;LI Qiang;HAO Yan-ming;WU Han(Department of Orthopaedics,Kunshan Hospital affiliated to Jiangsu University,Kunshan,Jiangsu,215300,China)
出处
《中国骨与关节杂志》
CAS
2018年第11期828-831,共4页
Chinese Journal of Bone and Joint
关键词
髋骨折
股骨骨折
骨质疏松性骨折
骨折固定术
髓内
Hip fractures
Femoral fractures
Osteoporotic fractures
Fracture fixation
intramedullary