有限切开钛缆捆扎辅助PFNA与单纯微创辅助PFNA治疗老年骨质疏松性31-A3型股骨粗隆间骨折的疗效对比

Comparisons of clinical results and complications between PFNA with cable and signal PFNA under extra limited incision in the treatment of 31-A3 trochanteric fractures in the elderly with osteoporosis

目的比较有限切开钛缆捆扎辅助股骨近端髓内钉(proximal femoral nail antirotation,PFNA)与单纯微创辅助PFNA治疗老年骨质疏松性31-A3型股骨粗隆间骨折患者的临床疗效。方法对2014年1月至2017年1月我院收治的46例老年31-A3型股骨粗隆间骨折患者,分别采用钛捆扎辅助PFNA (A组,23例)与骨拨或复位钳等辅助PFNA治疗(B组,23例),对比分析两组的手术时间、术中出血量、术后6个月起立行走情况,术后并发症发生率,两组骨折愈合时间及术后髋关节功能评分情况。结果两组获平均25.4(12～32)个月随访,切口均一期愈合,无感染、血管神经损伤,无下肢深静脉血栓形成、脂肪栓塞。两组骨折愈合时间(A组平均7.5个月,B组平均7.6个月)、术后末次随访髋关节功能评分(harris hip score,HHS)(A组平均82.6分,B组平均81.1分),两组相比差异无统计学意义(P=0.445);手术时间、术中出血量、术后6个月起立行走测试(time up andgtest,TUG)、术后并发症发生率,两组相比差异均有统计学意义(P<0.05),A组优于B组。结论对老年骨质疏松性31-A3型股骨粗隆间骨折采取钛缆捆扎辅助治疗可降低骨折复杂程度及手术难度、可使患者早期下地活动、减少术后并发症的发生。

Objective To compare the clinical results and complications of PFNA assisted with cable and signal PFNA in the treatment of trochanteric fractures(31-A3)in the elderly with osteoporosis.Methods Retrospectively analyzing 46 elderly patients with 31-A3 intertrochanteric femoral fractures,who were treated in our hospital from January 2014 to January 2017.For comparison,all patients were divide into 2 groups.Group A(n=23):PFNA assisted with cable.Group B(n=23):PFNA.Operation time,intraoperative blood loss,time up and go test 6 months postoperatively,postoperative complication rate,fracture healing time and postoperative hip functions were compared between the 2 groups.Results Forty-three patients were followed up for 12-32 months with an average of 25.4 months.Primary healing was achieved.No infection,neurovascular injury,thrombosis,or fat embolism was observed.There were no significant differences in union time(an average of 7.5 months in Group A and7.6 months in Group B),nor the latest HHS(an average of 82.6 in Group A and 81.1 in Group B)between the 2 groups(P=0.445).Significant differences were observed in operation time,intraoperative blood loss,time up and go test6 months postoperatively,postoperative complication rate(P<0.05).While Group A performed better than Group B.Conclusions Internal fixation of PFNA assisted with cable is demonstrated as a feasible,effective and safe treatment of 31-A3 femoral intertrochanteric fractures,which should be considered as a method of priority.