重建股骨矩与PFNA治疗老年不稳定性股骨粗隆间骨折效果比较

Comparison of Calcar Femorale Reconstruction and PFNA in the Treatment of Unstable Intertrochanteric Fractures in the Aged

目的分析重建股骨矩(股骨近端外侧锁定钢板联合前侧短重建钢板内固定)和近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)治疗老年不稳定股骨粗隆间骨折效果之间的差异。方法回顾性分析2015年5月～2017年5月于我院就诊的不稳定股骨粗隆间骨折并择期行外科手术的老年患者177例,按照手术方式的不同分为重建组(n=88)及PFNA组(n=89)。重建组行股骨近端外侧锁定钢板及前侧短重建钢板内固定术治疗,PFNA组则采用PFNA内固定术治疗,比较两组患者术中情况、术后恢复情况、术后3月疗效及术后1、3、6、12月髋关节功能恢复情况以及随访期间并发症发生率之间的差异。结果 PFNA组患者手术耗时、切口长度、术中出血量及总输血量均明显低于重建组(P=0. 001); PFNA组患者术后引流量、骨折临床愈合时间及术后完全负重时间明显低于重建组(P <0. 01); PFNA组术后3月的疗效优良率明显高于重建组(P <0. 05); PFNA组患者术后1月及3月Harris评分明显高于重建组(P=0. 001); PFNA组患者一般并发症及器械相关并发症发生率明显低于重建组(P <0. 05)。结论 PFNA对老年不稳定股骨粗隆间骨折治疗效果较好,能减少患者术中骨折周围组织的损伤,同时提升患者术后恢复效果,明显缩短患者骨折愈合时间,改善患者术后髋关节功能,且手术并发症较少。

Objective To analyze the difference between calcar femorale reconstruction( proximal lateral locking plates combined with short anterior reconstruction plates) and proximal femoral nail anti-rotation( PFNA) in the treatment of unstable intertrochanteric fractures in the elderly. Methods A retrospective analysis was carried out in 177 elderly patients with unstable intertrochanteric fractures in our hospital from May2015 to May 2017. According to the surgical methods,they were divided into the reconstruction group( n = 88)and the PFNA group( n = 89). The reconstruction group was treated with the internal fixation of the proximal femoral external locking plate and anterior short reconstruction plate. The PFNA group was treated with PFNA internal fixation. The difference of the intraoperative conditions,postoperative recovery,and hip function recovery at 1,3,6 and 12 months after surgery,and postoperative complications during follow-up were compared.Results Operation time,length of incision,intraoperative blood loss and total blood transfusion were significantly lower in the PFNA group than that of the reconstruction group( P = 0. 001). The postoperative drainage volume,fracture healing time and total weight-bearing time in the PFNA group were significantly lower than that of the reconstruction group( P < 0. 01). The 3-month excellent rate of the PFNA group was significantly higher than that in the reconstruction group( P < 0. 05). The 1-month and 3-month Harris score in the PFNA group were significantly higher than that of the reconstruction group( P = 0. 001). The incidence of general complications and device-related complications in the PFNA group was significantly lower than that of the reconstruction group( P < 0. 05). Conclusion PFNA is effective in the treatment of unstable intertrochanteric fractures in the elderly,which can reduce the damage of the surrounding tissue,improve the recovery effect,reduce fracture healing time and improve the hip joint activity. Its surgical complications are less.