长短髓内钉治疗老年股骨反转子间骨折的疗效比较

Comparison of short intramedullary nail and long intramedullary nail for the treatment of reverse oblique intertrochanteric fractures in the elderly

目的通过分析比较短髓内钉与长髓内钉治疗老年股骨反转子间骨折的效果,为反转子间骨折内植物的选择提供临床参考。方法回顾性分析2012年12月至2016年11月在枣庄市山亭诚德骨科医院治疗的47例老年股骨反转子间骨折的患者,根据内固定物的绝对长度与相对比例以及远端锁定器械不同分为短髓内钉(240 mm)与长髓内钉(300 mm以上)两组,其中短髓内钉组26例(55.3%),长髓内钉组21例(44.7%),观察两组患者的手术时间、术中出血量、输血量、术后负重时间、骨折愈合时间、术后并发症发生情况、髋关节功能恢复情况,日常生活能力评分按照Harris标准对患者功能进行评分。结果术后1年内有5例患者因意外及心血管疾病等其它的原因死亡,其中短髓内钉组3例,长髓内钉组2例,均与骨折无关,40例纳入研究的患者均完成了1年的随访,随访率(85.1%)。在手术时间、出血量、输血量方面,短髓内钉组患者手术时间为(33.5±1.0)min、出血量为(192±5)ml、输血量为(192±116)ml,明显少于长髓内钉组[(68.7±12.3)min、(313±37)ml、(370±122)ml],差异具有统计学意义(t=0.018,t=0.004,t=0.001,P<0.05)。短髓内钉组患者的术后负重时间[(8.3±2.8)d]、术后1年Harris评分[(81±3)分]、骨折愈合时间[(14.5±2.1)w]方面与长髓内钉组[(8.4±2.2)d、(80±4)分、(14.8±2.7)w)]比较,差异无统计学意义;两组术后均未发生切口不愈合或者感染、骨折延迟愈合或不愈合、下肢深静脉血栓形成、髋内翻、内固定松动及内固定周围骨折等情况。结论短髓内钉治疗老年股骨反转子间骨折的手术时间、出血量、输血量要优于长髓内钉,并不存在“中裤效应”,建议使用短髓内钉进行固定。

Objective To investigate the effect of short intramedullary nail and long intramedullary nail in the treatment of elderly patients with intertrochanteric fractures and provide clinical reference for the internal plants of the intertrochanteric fractures. Methods The clinical data of 47 elderly patients with intertrochanteric fractures treated in our hospital from December 2012 to November 2016 were retrospectively analyzed. Data were divided into short intramedullary nail (240 mm) and long intramedullary nail (300 mm above) groups according to different internal fixators, including 26 cases of long nail group, 21 cases of short nail group. The operation time, blood loss, blood transfusion, postoperative weight-bearing time, fracture healing time, postoperative complications, hip function recovery, daily living ability score in accordance with Harris score were observed to access the patient’s functional ability. Results Five patients died within one year after surgery due to accidental and cardiovascular diseases, which were not related to the fracture. Among them, 3 were in the long intramedullary nail group and 2 were in the short intramedullary nail group. The rest o were followed up for 1 years, the follow-up rate was 85.1%. In terms of operation time, blood loss and blood transfusion, the operation time [(33.5±1.04) min], blood loss [(192.5±5.2) ml], and blood transfusion [(191.8±115.6) ml] in the short intramedullary nail group were significantly less than those in the long intramedullary nail group. The difference was statistically significant (t=0.018, t=0.004, t=0.001, P<0.05). The postoperative weight-bearing time [(8.3±2.8) d], Harris score [(81±3) points], and fracture healing time [(14.5±2.1) w] in the short intramedullary nail group have no significant difference compared with the long intramedullary nail group [(8.4±2.2) d,(80±4) points,(14.8±2.7) w]. There is no postoperative incision infection or nonunion, fracture nonunion, deep venous thrombosis of lower extremity, hip varus, internal fixation loosening and internal fixation of the surrounding fractures. Conclusion For the aged femur intertrochanteric fracture, the time of operation, the amount of bleeding and the amount of blood transfusion in the treatment of the short intramedullary nail are better than that of the long intramedullary nail, and there is no “middle pants” effect and short intramedullary nail is recommended .