不同类型的不稳定型股骨粗隆间骨折对术后患者的早期活动的影响

Effect of different types of unstable intertrochanteric fractures on early postoperative motion

目的探讨股骨近端抗旋髓内钉(PFNA)治疗老年不稳定型股骨粗隆间骨折对患者活动能力的影响。方法选择2018年6月~2019年7月期间我院收治的不稳定股骨粗隆间骨折(ITF)及接受股骨近端抗旋髓内钉(PFNA)固定手术的患者126例患者作为研究对象。根据AO分型将患者分为两组,第一组为A2.2和A2.3患者(A22+A23组),第二组为A3.1和A3.2患者(A31+A32组)。评估两组患者的基本情况、术后并发症、随访、死亡率、术后复位、尖顶距(TAD)和Parker⁃Palmer活动评分(PPM)。结果两组在性别、年龄、患侧、ASA评分、麻醉类型、住院时间、手术时间、TAD值、复位值、死亡率等方面无显著性差异。A22+A23组患者的运动评分明显高于A31+A32组(P<0.05)。结论虽然TAD值与骨折复位状态无相关性,但A3型患者的PPM评分明显较差。因此,PFNA治疗术前AO分型为A3型的骨折比A2型的骨折疗效更差。

Objective To assess the impact of uniform anti⁃rotational proximal femoral intramedul⁃lary nail(PFNA)use on patient mobility status with the treatment of two different unstable intertrochan⁃teric femur fracture groups of geriatric patients.Methods 126 patients with unstable intertrochanteric fracture(ITF)in our hospital from June 2018 to July 2019 were selected as the research objects.The patients underwent proximal femoral anti rotation intramedullary nail(PFNA)and assigned to two groups according to AO classification,group 1:A2.2 and A2.3;group 2:A3.1 and A3.2.The demographic data of the patients,postoperative complications,follow⁃up,mortality status,postoperative reduction,tip⁃apex distance(TAD),and the Parker⁃Palmer mobility(PPM)score were evaluated.Results There were no statistically significant differences between the groups in terms of gender,age,affected side,ASA score,anesthesia type,duration of hospitalization,duration of surgery,TAD values,reduction values,or mortality rate.The mobility scores of group 1 patients were significantly higher than those of group 2(P<0.05).Conclusion There were not relationship found between the TAD values and the reduction status of the patients,but the PPM scores of the A3 cases were determined to be significantly worse.Therefore,fractures with a preoperative classification of AO type A3 can be expected to have worse results than A2 ITF fractures.