InterTAN与PFNA治疗老年骨质疏松AO/OTA 31-A2型股骨转子间骨折临床疗效的比较

Comparison of InterTAN nail and PFNA in managing AO/OTA 31-A2 intertrochanteric hip fracture in older osteoporotic patients

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.