InterTan钉与PFNA-Ⅱ内固定治疗老年股骨粗隆间骨折对尖顶距的影响研究

Effects of InterTan nail and PFNA-Ⅱ internal fixation on tip-apex distance in the treatment of unstable intertrochanteric fractures

目的探讨InterTan和PFNA-Ⅱ治疗老年股骨粗隆间骨折对尖顶距(tip-apex distance,TAD)的影响。方法对2016年1月至2018年6月在我院治疗的90例老年股骨粗隆间骨折患者,按照随机数字表法分为两组,分别采用PFNA-Ⅱ (45例)和InterTan (45例)治疗,其中PFNA-Ⅱ组男23例,女22例,年龄65~81岁,平均71岁;InterTan组男24例,女21例,年龄63~80岁,平均71岁。本组致伤原因:高处跌落伤32例,车祸伤26例,自行跌倒受伤32例。外侧壁危险型(对应AO分型中2.2、2.3型) 45例;外侧壁破裂型(对应AO分型中3.1~3.3型) 45例。比较两组手术时间、术中出血量和骨折愈合时间。术后1周、3个月和1年随访摄X线片,测量TAD,采用Harris评分评价髋关节功能,并进行Pearson相关性分析。结果 InterTan组手术时间长于PFNA-Ⅱ组,两组相比差异有统计学意义(P=0.001)。两组术中出血量、骨折愈合时间、术后1周和3个月TAD、术前、术后1周两组Harris评分相比,差异无统计学意义(P>0.05)。术后1年InterTan组TAD小于PFNA-Ⅱ组,两组相比差异有统计学意义(P<0.001)。术后3个月和1年InterTan组Harris评分明显高于PFNA-Ⅱ组,两组相比差异有统计学意义(P=0.000)。结论在老年股骨粗隆间骨折的治疗中,InterTan比PFNA-Ⅱ内固定更牢固,有利于维持合适的TAD,具有更好的防切割和沉降作用。

Objective To investigate effects of InterTan and PFNA-Ⅱ on tip-apex distance (TAD) in elderly femoral intertrochanteric fractures.Methods Ninety elderly patients with intertrochanteric fractures,admitted in our hospital from January 2016 to June 2018,were divided into two groups according to the random number table method(PFNA-Ⅱ group,n=45;InterTan group,n=45).PFNA-Ⅱ group:23 males and 22 females;an average age of71 years (range:65-81 years).InterTan group:24 males and 21 females;an average age of 71 years (range:63-80 years).Causes of injury:32 cases of the fall from the height,26 cases of car accident,and 32 cases of self-fall injury.The outer wall danger was observed in 45 cases (corresponding to 2.2 and 2.3 types in the AO classification);ruptured outer wall was noted in 45 cases (corresponding to 3.1 to 3.3 types in the AO classification).The operation time,intraoperative blood loss and fracture healing time were compared between the two groups.Follow-up X-rays were taken at 1 week,3 months,and 1 year after operation.The tip-apex distance was measured.The Harris score was used to evaluate hip functions,and Pearson correlation analysis was performed.Results The operation time of the InterTan group was longer than that of the PFNA-Ⅱ group with statistically significant differences (P=0.001).No significant differences were observed in bleeding volume,fracture healing time,TAD at 1 and 3 months after surgery,and Harris scores before and 1 week after surgery (P > 0.05).The TAD of the InterTan group was smaller than that of the PFNA-Ⅱ group 1 year after operation with statistically significant differences (P < 0.001).The Harris score of the InterTan group at 3 months and 1 year after surgery was significantly higher than that of the PFNA-Ⅱ group with statistically significant differences (P=0.000).Conclusions InterTan is stronger than PFNA-Ⅱ internal fixation in the treatment of elderly femoral intertrochanteric fractures,which is conducive to maintaining appropriate TAD with better anti-cutting and sedimentation effects.