股骨重建钉和解剖锁定钢板治疗不稳定性股骨粗隆间骨折合并同侧股骨干骨折的比较

Comparison of effect between femoral reconstruction nail and proximal femoral anatomic locking plate in patients with ipsilateral femoral shaft and unstable intertrochanteric fractures

目的:对比应用股骨重建钉(femoral reconstruction nail,FRN)和股骨近端解剖锁定钢板(proximal femoral anatomic locking plate,PFALP)治疗不稳定性股骨粗隆间骨折合并同侧股骨干骨折的疗效。方法:回顾性分析45例不稳定性股骨粗隆间骨折合并同侧股骨干骨折患者临床资料,比较两组患者平均手术时间,术中出血量,输血量,扶拐下地时间,骨折临床愈合时间,Harris评分及不良事件等的差异。结果:FRN组患者平均手术时间和扶拐下地时间均少于PFALP组[(62.4±19.3)min vs(79.1±22.7)min,P=0.02;(41.3±13.7)d vs(71.2±16.0)d,P<0.01],术中出血量明显多于PFALP组[(190.2±45.9)m L vs(161.0±39.3)m L,P=0.04];两组患者平均输血量和骨折愈合时间的差异无统计学意义[(122.2±96.4)m L vs(106.2±94.4)m L,P=0.38;(82.7±11.5)d vs(89.7±11.3)d,P=0.06]。术后3个月,FRN组患者平均Harris评分优于PFALP组[(81.10±7.25)分vs(75.26±8.17)分,P=0.02];术后6个月,两组Harris评分差异无统计学意义[(85.61±5.20)分vs(83.28±6.92)分,P=0.21]。FRN组和PFALP组患者分别发生不良事件2例和5例,组间差异无统计学意义(P=0.15)。结论:FRN和PFALP均是治疗不稳定性股骨粗隆间骨折合并同侧股骨干骨折的有效方式,FRN较PFALP手术时间和扶拐下地时间更短,但PFALP组术中出血量明显少于FRN组。

Objective:To compare the effect between femoral reconstruction nail and proximal femoral anatomic locking plate inpatients with ipsilateral femoral shaft and unstable intertrochanteric fractures. Methods:To summary the clinical data of 45 patients withipsilateral femoral shaft and unstable intertrochanteric fractures and compare the operation related indexes and the occurrence of adverseevents between two surgical methods. Results:The operative time and postoperative ambulation time on crutches of FRN group was shorterthan PFALP group[ (6 2 .4 ± 19. 3) min vs (79. 1 ±22. 7) min, = 0. 02; (4 1 .3 ± 13. 7) d vs (7 1 .2 ± 16. 0 W < 0. 01 ]. But theblood loss of FRN group was more than PFALP group[(1 9 0 . 2 ± 45. 9) mL vs (1 6 1.0 ±39. 3) mL, P = 0. 0 4 ]. The two groups in bloodtransfusion and healing time had no significant difference [ ( 122. 2 ± 96. 4 ) mL vs ( 106. 2 ± 94. 4 ) mL,f* = 0 .3 8 ;(8 2 .7 ± 1 1 .5 d )v s(8 9 .7 ± 1 1 .3 ) d ,P = 0 . 0 6 ]. The Harris score of FRN group was higher than PFALP group in 3 months after surgery (81. 10 ± 7. 25 vs75. 26 ± 8. 17,P = 0. 0 2 ). But there was no significant difference between two groups in 6 months after treatment (85. 61 ± 5.20 vs 83.28 ± 6. 92 ,P = 0. 21). The occurrence of adverse events of nail group and plate group was 2 and 5 respectively with no statistical significance(P = 0. 15). Conclusion:Reconstruction nail and proximal femoral locking anatomic plate both are effective surgical methods forthe treatment of ipsilateral femoral shaft and unstable intertrochanteric fractures, but the FRN could shorten operative time and postoperativeambulation time on crutches ; the PFALP can significantly reduce intraoperative blood loss.