动力髋螺钉与股骨近端防旋髓内钉治疗AO/OTA A1型老年稳定型转子间骨折的近期随访

Short-term follow-up of dynamic hip screw versus proximal femoral nail anti-rotation for type AO/OTA A1 intertrochanteric femoral fracture in older adults

背景:目前有许多研究者报道了动力髋螺钉和股骨近端防旋髓内钉治疗不稳定股骨转子间骨折的结果,但是对于二者治疗老年稳定型股骨转子骨折的治疗结果很少有研究,因为该类型骨折较易忽略。目的:比较和评估动力髋螺钉与股骨近端防旋髓内钉治疗稳定型(AO/OTAA1型)老年股骨转子间骨折的临床疗效。方法:回顾性分析山西省汾阳医院2013年1月至2017年1月收治的58例年龄>60岁,AO/OTA A1型老年股骨转子间骨折的临床资料,采用动力髋螺钉(n=20)和股骨近端防旋髓内钉(n=38)2种不同内固定物治疗,进行6-24个月的随访,对手术时间、术中失血量、住院时间、临床骨折愈合时间、术后疼痛缓解时间、术后3个月负重活动、术后6个月患髋功能及术后并发症等进行对比分析。结果与结论:(1)股骨近端防旋髓内钉组在平均手术时间、平均出血量、平均住院时间及术后疼痛缓解时间方面明显优于动力髋螺钉组,差异有显著性有意义(P <0.05);(2)2组术后临床骨折愈合时间(t=0.040,P>0.05)、3个月负重活动能力(χ2=0.030,P> 0.05)比较差异均无显著性意义;(3)术后6个月2组患髋关节功能Harris评分比较,差异无显著性意义(t=0.845,P> 0.05);(4)2组患者术后并发症发生率比较亦无明显不同;(5)结果表明,对于AO/OTA A1型老年股骨转子间骨折,虽然2种内固定方式具有相似的临床疗效,但股骨近端防旋髓内钉固定具有手术时间短、术中出血量少、住院天数短、术后疼痛缓解快的优点,是临床该型骨折固定更为良好的方式。

BACKGROUND:There are many studies concerning the treatment outcomes of dynamic hip screw and proximal femoral nail anti-rotation for unstable intertrochanteric fractures.However their effects on the treatment of stable intertrochanteric fractures in the elderly are rarely reported.OBJECTIVE:To compare and evaluate the clinical efficacy of dynamic hip screw and proximal femoral nail anti-rotation for stable(AO/OTA type A1)intertrochanteric fractures in the elderly.METHODS:Fifty-eight patients with AO/OTA type A1 intertrochanteric femoral fracture and aged older than 60 years admitted at Shanxi Fenyang Hospital from January 2013 to January 2017 were analyzed retrospectively.The patients were treated with dynamic hip screw(n=20)and proximal femoral nail anti-rotation(n=38),and followed up for 6-24 months.The operation time,intraoperative blood loss,hospitalization time,fracture healing time,postoperative pain relief time,clinical fracture healing time,weight-bearing activity at postoperative 3 months,hip joint function at postoperative 6 months,and postoperative complications were compared.RESULTS AND CONCLUSION:(1)The mean operation time,mean blood loss,mean hospitalization time and postoperative pain relief time in the proximal femoral nail anti-rotation group were significantly superior to those in the dynamic hip screw group(P<0.05).(2)There was no significant difference in the fracture healing time(t=0.040,P>0.05)and weight-bearing activity at postoperative 3 months(χ2=0.030,P>0.05)between two groups.(3)There was no significant difference(t=0.845,P>0.05)in the Harris hip scores between two groups at 6 months after operation.(4)No significant difference was found in the incidence of complication between two groups.(5)In summary,for type AO/OTA A1 intertrochanteric fractures in the elderly,the two treatments have similar clinical outcomes,but proximal femoral nail anti-rotation fixation shows shorter operation time,less blood loss,shorter hospitalization time and quicker pain relief after surgery.So it is the preferred implant for this type of fractures.