解剖型髓内钉和股骨近端防旋髓内钉治疗老年股骨转子间骨折的临床对照研究

Clinical comparative study of Zimmer natural nail system and proximal femoral nail antirotation in treatment of intertrochanteric fractures in the elderly

目的比较解剖型髓内钉(ZNN)和股骨近端防旋髓内钉(PFNA)治疗老年股骨转子间骨折的临床疗效。方法回顾性分析上海市第十人民医院2015年6月至2018年6月手术治疗的208例大于60岁的老年股骨转子间骨折患者的临床资料,所有患者均获得1年以上随访。ZNN治疗96例,PFNA治疗112例。比较两组患者的手术时间、术中失血量、术后尖顶距、骨折愈合时间、术后并发症发生率、髋部外侧疼痛情况和术后1年随访时髋关节Harris评分。结果两组患者平均随访(18.7±5.6)个月。手术时间ZNN组(71.3±15.1)min,PFNA组(67.3±7.2)min,两组间存在差异(P=0.013)。术中失血量ZNN组为(60.1±3.8)mL,PFNA组为(59.1±5.8)mL,差异无统计学意义(P>0.05)。术后尖顶距ZNN组(17.3±3.2)mm,PFNA组(16.8±4.6)mm,差异无统计学意义(P>0.05)。骨折愈合时间ZNN组(15.5±2.5)周,PFNA组(15.1±1.7)周,差异无统计学意义(P>0.05)。术后并发症ZNN组4例(4.2%),其中1例股骨头坏死,3例髋螺钉切割,PFNA组6例(5.4%),其中2例股骨头坏死,4例髋螺钉切割,并发症发生率两组无统计学差异(P>0.05)。术后1年随访时髋关节Harris评分ZNN组为(91.2±4.5)分,PFNA组为(92.5±6.7)分,无统计学差异(P>0.05)。术后1年随访时髋部外侧疼痛发生率ZNN组为3.1%(3例),PFNA组为11.6%(13例),ZNN组明显低于PFNA组,有统计学差异(P=0.022)。结论ZNN和PENA均是治疗老年股骨转子间骨折的有效手段,ZNN组手术时间略长于PFNA组,对于不能耐受较长时间手术的老年患者推荐使用PFNA。ZNN结合了人体股骨前弓设计,对于股骨前弓较大的患者,推荐使用ZNN治疗。

Objective To compare the clinical efficacy of Zimmer natural nail system(ZNN)and proximal femoral nail antirotation(PFNA)in treatment of intertrochanteric fractures in the elderly.Methods We retrospectively analyzed 208 patients with senile intertrochanteric fractures older than 60 years who underwent surgery from June 2015 to June 2018 in Shanghai 10th People’s Hospital.All patients were followed up for more than 1 year.Ninety-six patients were treated with ZNN while 112 cases treated with PFNA.The operation duration,intraoperative blood loss,postoperative Tip Apex Distance(TAD),fracture healing time,postoperative complications,pain at lateral hip and hip Harris score at 1 year follow-up were compared between the two groups.Results The average follow-up time was 18.7±5.6 months.The operation duration was 71.3±15.1 minutes in the ZNN group and 67.3±7.2 minutes in the PFNA group,with statistically significant difference(P=0.013).The intraoperative blood loss was 60.1±3.8 mL in the ZNN group and 59.1±5.8 mL in the PFNA group;there was no statistically significant difference.The postoperative TAD was 17.3±3.2 mm in the ZNN group and 16.8±4.6 mm in the PFNA group;there was no statistically significant difference.The fracture healing time was 15.5±2.5 weeks in the ZNN group and 15.1±1.7 weeks in the PFNA group;there was no statistically significant difference.Postoperative complications were 4 cases(4.2%)in the ZNN group,including 1 case of femoral head necrosis and 3 cases of hip screw cut-out,whereas 6 cases(5.4%)were reported in the PFNA group,including 2 cases of femoral head necrosis and 4 cases of hip screw cut-out.There was no statistically significant difference in terms of the incidence of complications between the both groups.At 1 year follow-up,the Harris scores of the two groups were 91.2±4.5 points and 92.5±6.7 points,respectively,without statistically significant difference.The incidence of hip lateral pain at 1 year follow-up was 3.1%(3/96)in the ZNN group and 11.6%(13/112)in the PFNA group.It was significantly lower in the ZNN group than that in the PFNA group(P=0.022).Conclusion Both implants are effective methods for the treatment of intertrochanteric fractures in the elderly.The operation duration in the ZNN group is slightly longer than that in the PFNA group,thus PFNA is recommended for elderly patients who cannot tolerate long operation duration.As ZNN features the natural anterior arch of human femur,it is therefore recommended for patients with large femoral anterior arch.