膝关节骨性关节炎老年股骨转子间骨折行股骨近端防旋髓内钉内固定评价

Evaluation of internal fixation with proximal femoral nail antirotation in elderly knee osteoarthritis patients with femoral intertrochanteric fractures

背景:股骨近端防旋髓内钉是治疗老年股骨转子间骨折常用的内固定系统,同时老年人多伴有膝关节骨性关节炎,其对股骨转子间骨折术后疗效可能会造成影响。目的:探讨骨折侧膝关节骨性关节炎对老年股骨转子间骨折股骨近端防旋髓内钉内固定术后疗效的影响。方法:纳入92例65岁以上股骨转子间骨折采用股骨近端防旋髓内钉内固定治疗患者,按照术前膝关节骨性关节炎X射线K-L分级分为5组:0级为A组(13例),Ⅰ级为B组(18例),Ⅱ级为C组(23例),Ⅲ级为D组(22例),Ⅳ级为E组(16例)。记录5组住院时间、术后并发症、术后下地时间、骨折愈合时间,术后1,3,6个月的髋关节Harris评分和日常生活能力Barthel指数计分。研究得到承德医学院附属医院伦理委员会批准。结果与结论:①5组住院时间比较差异无显著性意义(P>0.05);②C、D组术后下地时间及骨折愈合时间长于A、B、C组(P<0.05);③C组术后并发症发生例数多于A、B组(P<0.05),D、E组术后并发症发生例数均多于A、B、C组(P<0.05);④C、D组术后1,3,6个月的Harris及Barthel评分低于A、B组(P<0.05),E组术后1,3,6个月的Harris及Barthel评分均低于其他4组(P<0.05);⑤结果表明,膝关节骨性关节炎分级越高,对股骨近端防旋髓内钉内固定治疗老年股骨转子间骨折患者术后疗效的影响越大,表现为术后并发症增加、术后下地时间及骨折愈合时间延长、髋关节功能及日常生活能力下降。

BACKGROUND:Proximal femoral nail antirotation is a commonly used internal fixation system for the treatment of femoral intertrochanteric fracture in the elderly.Simultaneously,the elderly are often associated with knee osteoarthritis,which may affect the postoperative effect of femoral intertrochanteric fracture.OBJECTIVE:To investigate the effect of knee osteoarthritis at the fracture side on the efficacy of postopenxtine proximal femoral nail antirotation in elderly femoral intertrochanteric fractures.METHODS:Totally 92 patients aged over 65 years old with femoral intertrochanteric fractures treated with proximal femoral nail antirotation internal fixation were divided into five groups according to the preoperative knee X-ray Kellgren-Lawrence grade:grade 0 as group A(13 cases),grade I as group B(18 cases),grade II as group C(23 cases),grade III as group D(22 cases),and grade IV as group E(16 cases).The hospitalization time,postoperative complications,postoperative landing time,fracture healing time,hip Harris score and Barthel index score of daily living ability at 1,3 and 6 months after operation were recorded in the five groups.This study was approved by the Ethics Committee of Affiliated Hospital of Chengde Medical University.RESULTS AND CONCLUSION:(1)There was no significant difference in the length of hospital stay among the five groups(P>0.05).(2)The postoperative landing time and fracture healing time of group D and group C were longer than those in group A,group B,and group C(P<0.05).(3)The number of postoperative complications of group C was more than those in group A and group B(P<0.05).The number of postoperative complications of group D and group E was more than that in group A,group B and group C(P<0.05).(4)The scores of Harris and Barthel index of group C and D were lower than those in group A and B at 1,3 and 6 months after operation(P<0.05).The scores of Harris and Barthel index of group E was lower than those in group A,group B,group C and group D at 1,3 and 6 months after operation(P<0.05).(5)The results showed that the higher the grade of knee osteoarthritis,the greater the influence on the postoperative efficacy of proximal femoral nail antirotation in the treatment of elderly patients with femoral intertrochanteric fracture.It is manifested by increased postoperative complications,prolonged postoperative landing time and fracture healing time,and the decrease of hip function and ability of daily living.