网格定位器辅助植入防旋股骨近端髓内钉治疗老年股骨转子间骨折

Effectiveness of proximal femoral nail antirotation assisted by mesh locator for intertrochanteric fracture in the elderly

目的探讨网格定位器辅助植入防旋股骨近端髓内钉(proximal femoral nail antirotation,PFNA)治疗老年股骨转子间骨折的疗效。方法选择2014年8月-2017年7月收治的94例老年股骨转子间骨折患者作为研究对象,按随机数字表法分为试验组(48例)和对照组(46例)。试验组骨折闭合复位后,采用网格定位器辅助植入PFNA;对照组采用常规方法植入PFNA。两组患者性别、年龄、致伤原因、受伤至入院时间、骨折侧别及分型以及合并内科疾病等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。记录两组手术时间、术中出血量、术中透视次数、住院时间、切口长度及并发症发生情况。术后3 d采用疼痛视觉模拟评分(VAS)评价患者疼痛程度;术前及术后3、6、9个月采用Harris评分评价髋关节功能。结果与对照组相比,试验组手术时间及切口长度均缩短,术中出血量及透视次数均减少,术后疼痛程度降低,差异均有统计学意义(P<0.05)。两组患者住院时间差异无统计学意义(P>0.05)。两组患者术后均获随访,随访时间9~12个月,平均10.6个月。X线片复查示,两组骨折均愈合;对照组骨折愈合时间为(11.2±3.2)周,试验组为(11.6±2.9)周,差异无统计学意义(t=1.262,P=0.120)。术前及术后3、6、9个月,两组髋关节Harris评分比较,差异均无统计学意义(P>0.05)。术后试验组出现切口感染1例、髋内翻2例、压疮1例,并发症发生率为8.3%,对照组出现髋内翻1例、压疮2例、内固定丢失1例,并发症发生率为8.7%;两组并发症发生率比较,差异无统计学意义(χ~2=0.783,P=0.112)。结论网格定位器辅助植入PFNA治疗老年股骨转子间骨折可行,与传统术式相比能缩短手术时间、减小手术切口、减轻患者术后疼痛。

Objective To explore the effectiveness of proximal femoral nail antirotation(PFNA) assisted by mesh locator in treatment of intertrochanteric fracture in the elderly. Methods Ninety-four elderly patients with intertrochanteric fractures admitted between August 2014 and July 2017 were selected as the study subjects. They were randomly divided into trial group(48 cases) and control group(46 cases). In trial group, PFNA was implanted assisted by mesh locator after closed reduction;while in control group, PFNA was implanted by conventional method. There was no significant difference between the two groups in terms of gender, age, cause of injury, time from injury to admission,fracture side and classification, and medical complications(P>0.05). The operation time, intraoperative blood loss,fluoroscopy times, hospital stay, incision length, and complications were recorded. Visual analogue scale(VAS) was used to evaluate the degree of pain at 3 days after operation, and Harris score was used to evaluate hip function before operation and at 3, 6, and 9 months after operation. Results Compared with control group, the operation time and incision length of trial group shortened, the blood loss and fluoroscopy times reduced, the pain after operation alleviated obviously;the differences between the two groups were significant(P<0.05). There was no significant difference in hospital stay between the two groups(P>0.05). The patients in both groups were followed up 9-12 months, with an average of 10.6 months. X-ray films showed that the fractures healed in both groups, and the healing time in control group was(11.2±3.2) weeks, while that in trial group was(11.6±2.9) weeks, showing no significant difference between the two groups(t=1.262, P=0.120). There was no significant difference in Harris score between the two groups before operation and at 3, 6, and 9 months after operation(P>0.05). There was 1 case of incision infection, 2 cases of coxa vara, and 1 case of pressure ulcer in trial group, and the incidence of complications was 8.3%. There was 1 case of coxa vara, 2 cases of pressure ulcer, and 1 case of internal fixation loss in control group, and the incidence of complications was 8.7%. There was no significant difference in the incidence of complications between the two groups(χ~2=0.783, P=0.112). Conclusion It is feasible to implant PFNA assisted by mesh locator in treatment of intertrochanteric fracture in the elderly. Compared with the traditional operation, it can shorten the operation time, shorten the incision, and relieve the pain after operation.