股骨近端防旋转髓内钉与股骨近端锁定加压板治疗股骨转子下骨折的比较

Clinical outcome of proximal femoral nail antirotation versus proximal femur locking compression plate fixation of subtrochanteric fractures

目的比较亚洲型股骨近端防旋转髓内钉(proximal femoral nail antirotationⅡ,PFNA-Ⅱ)和股骨近端锁定加压板(proximal femur locking compression plate,PF-LCP)治疗股骨转子下骨折的临床效果。方法回顾性分析自2013年1月至2016年12月于我院采用PFNA-Ⅱ或PF-LCP治疗的54例股骨转子下骨折病人的病例资料,男26例,女28例;年龄为30~95岁,平均(69±15)岁。根据手术方法不同分为:PFNA-Ⅱ组32例、PF-LCP组22例,两组一般资料比较,差异均无统计学意义(均P>0.05)。术前评估病人的年龄、性别、受伤肢体、骨折分型、受伤机制和美国麻醉医师协会(American Society of Anesthesiologists,ASA)评分及疼痛视觉模拟量表(visual analogue scale,VAS)评分,对比两组病人的术后6个月骨折愈合率、术后2周VAS评分、总骨折愈合率、术后输血病人比例、术后并发症情况及末次随访髋关节Harris评分。结果所有病人手术切口均顺利愈合、无感染,病人术后均能根据医嘱进行功能及康复锻炼。54例病人均获得随访,随访时间为7~20个月,平均(12±3)个月。PFNA-Ⅱ组病人在术后输血量、术后6个月内愈合率、最终愈合率,以上指标与PF-LCP组比较,差异均有统计学意义(均P<0.05)。PFNA-Ⅱ组骨性愈合的病人Harris评分、并发症例数和术后2周VAS评分,以上指标与PF-LCP组比较,差异均无统计学意义(均P>0.05)。PFNA-Ⅱ组病人无内固定松动、失败,PF-LCP组出现3例内固定物断裂,两组内固定失败率比较差异有统计学意义(χ~2=4.620,P=0.032)。结论相较于PF-LCP治疗,PFNA-Ⅱ治疗转子下骨折具有并发症少、愈合率高的优点,可考虑作为治疗转子下骨折的首选治疗方案。

Objective To compare the clinical outcomes of two fixation methods for subtrochanteric fractures using proximal femoral nail antirotation(PFNA-Ⅱ)and proximal femur locking compression plate(PF-LCP).Methods The radiological and medical information of all the54patients with subtrochanteric fractures in our hospital was retrospectively analyzed from January2013to December2016.There were26males and28females,with an average age of69±15years(range,30-95years).The patients were divided into PFNA-Ⅱgroup and PF-LCP group.There was no significant difference in the general data between the two groups(P>0.05).Preoperative variables including age,sex,affected side,fracture classification,injury mechanism,American Society of Anesthesiologists(ASA)score and VAS score were evaluated.The total union rate,VAS score atsecond week after operation,postoperative union rate within6months,blood transfusion rate,postoperative complications and Harris hip score at the last follow?up were compared.Results The surgical incisions in all patients were healed without infection.The function and rehabilitation exercises were done according to doctors advice.All of the54patients were followed up with the average follow-up time of(12±3)months(range:7to20months).In the PFNA-Ⅱgroup and PF-LCP group,blood transfusion rate was40.6%(13cases)and68.2%(15cases)respectively.There were statistically differences between two groups on blood transfusion rate,bone union within6months after operation,bone union eventually(all P<0.05).No significant difference were found in HHS score,compications and VAS scores at2nd week after operation between the two groups(all P>0.05).In the PFNA-Ⅱgroup,there was no fixation loosening and failure.There were3cases of implant fracture in the PF-LCP group and no loosening or instability in the rest patients.The failure rate of PF-LCP group was significant higher than that of the PFNA-Ⅱgroup(χ2=4.620,P=0.032).Conclusion Compared to PF-LCP,PFNA-Ⅱcan achieve high union rate and few complications,and can be considered as the first choice for subtrochanteric fractures.