股骨近端防旋髓内钉与重建髓内钉治疗老年股骨转子下骨折的疗效比较

Comparative effectiveness between lengthened proximal femoral nail antirotation and reconstruction intramedullary nail in the treatment of subtrochanteric fracture in the elderly

目的探讨股骨近段防旋髓内钉(proximal femoral nail antirotation,PFNA)与重建钉治疗老年股骨转子下骨折的临床疗效。方法我院收治的55例老年股骨转子下骨折患者,根据手术方式分为PFNA组(30例)和重建髓内钉组(25例)。比较两组手术情况、治疗效果、生活活动能力及术后并发症情况。结果PFNA组1例因冠心病死亡失访,其余患者均获得随访。PFNA组在切口长度、手术时间、术中出血、术中透视时间、骨折愈合时间方面均优于重建髓内钉组(P<0.05)。两组术后改良Barthel指数均提高(P<0.05),术后6月内PFNA组高于重建髓内钉组,术后6月后组间比较差异无统计学意义(P>0.05)。并发症方面,重建髓内钉组1例发生反"Z"字效应。结论PFNA术中操作容易,创口小,术中出血少,在术后早期提供足够稳定性,值得推广应用。

Objective To investigate the clinical efficacy of lengthened proximal femoral nail antirotation(PFNA)and reconstruction intramedullary nail in the treatment of subtrochanteric fracture in the elderly.Methods A retrospective study was conducted on 55 elderly patients treated in our hospital.According to the operation mode,the patients were assigned to PFNA group(n=30)and reconstruction intramedullary nail group(n=25).Surgical condition,treatment effect,living activity and postoperative complications were compared between the two groups.Results All the patients in the PFNA group were followed up except one case dying of coronary disease.The incision length,operation time,intraoperative bleeding,intraoperative fluoroscopy time,and fracture healing time of the PFNA group were significantly better than those in the reconstructive nail group.The modified Barthel index of the two groups was significantly improved,and the PFNA group was higher than the reconstruction nail group within 6 months of operation(P<0.05).There was no significant difference between the two groups after 6 months of operation(P>0.05).In terms of complications,1 patient in the reconstruction nail group was found to have an anti-Z effect after 1 month of operation.Conclusion In the treatment for subtrochanteric fracture,the lengthened PFNA fixation has advantages over reconstruction intramedullary nail in terms of easier procedure,minor trauma,and less intraoperative bleeding.It is worth to be promoted.