APFN及PFNA-Ⅱ髓内钉技术治疗股骨粗隆间骨折的有效性和安全性比较

Efficacy and Safety of APFN and PFNA-Ⅱin Treatment of Femoral Intertrochanteric Fractures

目的比较亚洲型股骨近端髓内钉(APFN)及二代股骨近端抗旋髓内钉(PFNA-Ⅱ)髓内钉技术治疗老年股骨粗隆间骨折的有效性和安全性。方法回顾性分析2017年2月至2018年2月在绵阳市第三人民医院骨二科行手术治疗的85例单侧股骨粗隆间骨折患者的临床资料,根据手术方式不同分为PFNA-Ⅱ组(n=40)和APFN组(n=45)。比较两组手术时间、术中出血量、住院时间、骨折愈合时间,治疗前后髋关节Harris评分及术后并发症发生情况。结果两组手术时间、术中出血量、术后尖顶距、住院时间、骨折愈合时间比较差异无统计学意义(P>0.05)。两组术后Harris评分均随恢复时间延长逐渐升高,术后3个月、6个月、12个月,APFN组Harris评分均高于PFNA-Ⅱ组[(76.4±4.8)分比(70.4±5.5)分、(80.2±5.1)分比(75.4±3.7)分、(83.7±3.9)分比(76.2±2.8)分](P<0.05)。两组术后各项并发症及总并发症发生率比较差异无统计学意义(P>0.05);术后12个月,APFN组股骨颈短缩低于PFNA-Ⅱ组[(4.6±1.1)mm比(5.4±1.8)mm](P<0.01)。结论PFNA-Ⅱ和APFN在治疗股骨粗隆间骨折方面的临床效果均较好,但APFN系统在恢复髋关节功能方面的疗效更满意。

Objective To evaluate the efficacy and safety of Asian proximal femoral intramedullary nail(APFN)and proximal femoral nail anti-rotation-Ⅱ(PFNA-Ⅱ)in the treatment of femoral intertrochanteric fracture of the elderly.Methods From Feb.2017 to Feb.2018,85 patients with unilateral intertrochanteric fracture of femur who were operated in Department Two of Orthopedics,the Third Hospital of Mianyang were analyzed retrospectively.According to the different operation methods,they were divided into a PFNA-Ⅱgroup(n=40)and an APFN group(n=45).The operation time,intraoperative hemorrhage,postoperative tip-apex distance,hospitalization time,fracture healing time,Harris score of hip joint before and after treatment and postoperative complications were compared between the two groups.Results There was no significant difference in operation time,intraoperative hemorrhage,postoperative tip-apex distance,hospitalization time and fracture healing time between the two groups(P>0.05).After operation,the Harris scores of the two groups gradually increased with extended recovery time,the Harris score of the APFN group was higher than that of the PFNA-Ⅱgroup[(76.4±4.8)vs(70.4±5.5),(80.2±5.1)vs(75.4±3.7),(83.7±3.9)vs(76.2±2.8)](P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05);12 months after operation,the femoral neck shortening of the APFN group was lower than that of the PFNA-Ⅱgroup[(4.6±1.1)mm vs(5.4±1.8)mm](P<0.01).Conclusion Both PFNA-Ⅱand APFN internal fixation have achieved good clinical results in the treatment of femoral intertrochanteric fracture,while APFN system is more satisfactory in restoring hip joint function.