股骨近端防旋髓内钉小切口治疗老年股骨粗隆间骨折的效果和安全性分析

Effect and safety of proximal femoral anti-rotation intramedullary nail in the treatment of femoral intertrochanteric fracture in the elderly

目的研究采用股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)小切口治疗老年股骨粗隆间骨折的临床效果和安全性。方法选择2015年1月至2017年1月期间我院收治的100例老年股骨粗隆间骨折病人,按照随机数字表法分为2组,每组50例,对照组采取动力髋螺钉内固定术治疗,观察组采用小切口闭合复位PFNA内固定术治疗,比较2组老年股骨粗隆间骨折病人的手术情况、术后恢复情况、术后疼痛评分、髋关节功能恢复情况、并发症发生率。结果观察组手术时间、术中出血量、术后下床活动时间、住院时间、骨折愈合时间均低于对照组(P<0. 05)。在术后各个时间点,观察组疼痛评分均较对照组低(P<0. 05)。观察组的髋关节功能恢复优良率为96%,对照组为80%,差异有统计学意义(P<0. 05)。2组病人术后髋关节功能评分均较术前显著增高(P<0. 05),且观察组术后高于对照组(P<0. 05)。观察组的术后并发症发生率为4%,对照组为18%,2组间比较差异有统计学意义(P<0. 05)。结论在老年股骨粗隆间骨折治疗中,应用PFNA小切口内固定术切实可行,安全有效,可促使病人骨折有效愈合,促使病人髋关节功能有效恢复。

Objective To explore the clinical efficacy and safety of proximal femoral nail antirotation(PFNA) in the treatment of femoral intertrochanteric fracture in the elderly. Methods A total of 100 elderly patients with femoral intertrochanteric fractures treated in our hospital between January2015 and January 2017 were recruited and randomized into two groups according to a random number table method with 50 cases in each group. The control group was treated with dynamic hip screw fixation.The observation group was treated with small incision closed reduction and PFNA internal fixation. The operation conditions,postoperative recovery,pain scores,recovery of hip function,and incidence of complications were compared between the two groups. Results The intraoperative blood loss,operation time,postoperative ambulation time,hospital stay,and fracture healing time of observation group were significantly lower than those of the control group(P<0. 05). The pain score in the observation group was lower than that in the control group(P<0. 05). The hip function recovery rate in the observation group was 96%,which was significantly higher than that of the control group(80%). Hip function scores in both groups were significantly higher than those before surgery(P<0. 05),especially in the observation group(P<0. 05). The incidence rate of postoperative complications was 4% in the observation group and lower than that in the control group(18%)(P< 0. 05). Conclusions The proximal fixation of the femoral nails is practical,safe and effective in the treatment of intertrochanteric fractures in the elderly. It can promote the healing of fractures and the effective recovery of hip joint function.