股骨近端防旋髓内钉和InterTAN髓内钉治疗股骨粗隆间反斜型骨折的疗效比较

Efficacy of proximal femoral nail antirotation and Inter TAN in the treatment of femoral intertrochanteric oblique fracture

目的比较股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)和InterTAN髓内钉治疗股骨粗隆间反斜形骨折的疗效差异。方法回顾性分析2015年1月至2016年6月保定第七医院采用PFNA和InterTAN两种髓内钉治疗股骨反转子间斜行骨折共64例病人的临床资料,其中PFNA组39例,InterTAN组25例。比较两组一般资料、术前美国麻醉医师协会(ASA)分级、受伤前活动水平以及手术切口长度、手术时间、术中失血量、住院时间、Harris评分、完全负重时间。结果两组术前ASA分级、受伤前活动状态及手术切口长度、住院时间、Harris评分,均差异无统计学意义(P>0.05);PFNA组在手术时间(59.3±7.6)min、术中失血量(167.6±96.2)mL方面,优于InterTAN组(76.1±9.4)min、(249.1±87.3)mL(P<0.05);在完全负重时间方面,InterTAN组(8.7±3.4)周优于PFNA组(11.3±2.7)周(P<0.05)。结论 PFNA和InterTAN两种髓内钉均有出血较少、固定牢固、并发症少等优点,但又各有优势。PFNA髓内钉技术较为成熟、操作方便、组织损伤小,临床应用广泛;而InterTAN髓内钉稳定性较高,为近年新发展的术式,临床应用前景更为广阔。

Objective To compare the efficacy of proximal femoral nail antirotation(PFNA)and InterTAN intramedullary nail in the treatment of intertrochanteric synovial fracture of the femur.Methods The clinical data of 64 patients with femoral anterograde oblique fracture treated with PFNA and InterTAN were analyzed retrospectively from January 2015 to June 2016.Among them,39 cases were treated with PFNA and 25 cases with InterTAN.The time of ASA classification,the level of preoperative injury,the length of operation,the time of operation,the amount of blood loss during operation,the time of hospitalization,the Harris score and the complete weight-bearing time were compared between the two groups.Results There were no significant difference between the two groups in general data,preoperative ASA classification,pre-injury activity level,the length of incision,length of hospitalization and Harris score(P>0.05).PFNA group were superior than InterTAN group in average operation time[(59.3±7.6)min vs.(76.1± 9.4)min]and intraoperative blood loss[(167.6±96.2)mL vs.(249.1±87.3)mL](P<0.05).InterTAN group were better than PFNA group in complete weight-bearing time[(8.7±3.4)w vs.(11.3±2.7)w](P<0.05).Conclusion Both PFNA and InterTAN intramedullary nail have the advantages of less bleeding,firm fixation and less complication,with their own advantages.PFNA intramed- ullary nail technology is more mature,easy to operate,tissue damage is small and application is extensive.InterTAN intramedullary nail stability is high,which is the new development of the operation in recent years and application has yet to be improved.PFNA and InterTAN intramedullary nail both could achieve a solid fixed requirements,InterTAN intramedullary nail application prospects is more broad.