PFNA置入位点设计对股骨粗隆间骨折患者疗效及安全性的影响

Effect of PFNA placement site design on efficacy and safety of patients with femoral intertrochanteric fracture

目的探讨不同置入位点对股骨粗隆间骨折(IFF)患者股骨近端防旋髓内钉(PFNA)手术有效性及安全性的影响。方法回顾性分析2015年3月—2018年11月常州市金坛区人民医院收治IFF患者122例,男性85例,女性37例;年龄60~79岁,平均70.1岁。按手术方式不同分为定位点内移组(63例)和PFNA组(59例)。PFNA组行传统PFNA进针点置入髓内钉,定位点内移组则由传统PFNA定位点内移0.5~0.8cm置入髓内钉。比较两组患者围手术期指标、髓内钉一次置入成功率、术中透视次数,随访6个月采用Harris髋关节功能评分评价两组患者髋关节功能,并记录并发症情况。结果两组患者住院时间和首次负重时间比较差异无统计学意义(P>0.05);定位点内移组手术时间、术中出血量、术中透视次数、骨折愈合时间均显著少于PFNA组[(63.55±17.81)min vs.(82.74±20.66)min、(41.22±12.69)mL vs.(63.58±14.59)mL、(5.13±1.77)次vs.(7.26±1.58)次、(4.12±1.33)个月vs.(5.14±1.27)个月,P<0.05]。定位点内移组导针一次性置入成功率显著高于PFNA组(96.83%vs.84.75%),组间比较差异均有统计学意义(P<0.05)。随访6个月,两组患者髋关节Harris评分优良率(93.65%vs.94.92%)比较差异无统计学意义(P>0.05)。定位点内移组出现内固定物松动、断裂、螺旋刀片切割股骨头、髋内翻、骨折移位等并发症比例与PFNA组比较差异无统计学意义(P>0.05)。结论在PFNA术中将传统定位点内移0.5~0.8cm能够提高髓内钉一次性置入成功率,缩短手术时间,减少出血,避免术中多次透视,安全可靠。

Objective To explore the effect of different placement sites on the efficacy and safety of the proximal femoral nail anti-rotation(PFNA)in patients with intertrochanteric fracture of the femur(IFF).Methods Totally 122 IFF patients were admitted to Jintan District People’s Hospital from Mar.2015 to Nov.2018.There were 85 males and 37 females,with an average age of 70.1 years(range,60-79 years).According to the operation method,patients were divided into the positioning point shift inward group(63 cases)and the PFNA group(59 cases).In the PFNA group,the intramedullary nail was inserted at the traditional PFNA needle point;in the positioning point shift inward group,the intramedullary nail was inserted 0.5-0.8cm from the traditional PFNA fixation point.The perioperative indicators,the success rate of intramedullary nail insertion,and the number of intraoperative fluoroscopy were compared between the two groups.Patients were followed up for 6 months,the Harris hip joint function score was used to evaluate the hip joint function,and the complications of the two groups were recorded.Results There was no significant difference between the two groups of patients in hospitalization time and the first weight bearing time(P>0.05);The operation time,intraoperative blood loss,intraoperative fluoroscopy and fracture healing time in the positioning point shift inward group were significantly less than those in the PFNA group[(63.55±17.81)minutes vs.(82.74±20.66)minutes,(41.22±12.69)mL vs.(63.58±14.59)mL,(5.13±1.77)times vs.(7.26±1.58)times,(4.12±1.33)months vs.(5.14±1.27)months,P<0.05].The success rate of one-time implantation in the positioning point shift inward group was significantly higher than that in the PFNA group(96.83%vs.84.75%),and the differences between the groups were statistically significant(P<0.05).There was no significant difference in the excellent and good rate of Harris scores between the two groups(93.65%vs.94.92%,P>0.05);there was no significant difference in the proportion of internal fixation loosening,fracture,spiral blade cutting of the femoral head,hip varus,fracture displacement,and other complications in the positioning point shift inward group compared with the PFNA group(P>0.05).Conclusion In PFNA operation,the traditional positioning point is moved inward by 0.5-0.8cm,which can improve the success rate of one-time intramedullary nail insertion,shorten the operation time,reduce bleeding,avoid multiple intraoperative fluoroscopy,and is safe and reliable.