老年股骨粗隆间骨折患者应用防旋股骨近端防旋髓内钉与近端解剖钢板的疗效分析

Curative effect of proximal femoral nail anti-rotation and anatomic proximal femoral locking plate on elderly patients with femoral intertrochanteric fractures

目的比较老年股骨粗隆间骨折患者应用防旋股骨近端防旋髓内钉(PFNA)与近端解剖钢板(ALP)的疗效。方法前瞻性选取2016年2月至2019年4月淮南市新华医院收治的股骨粗隆间骨折患者70例,按照随机数字表法将其均分PFNA组(n=35)和ALP组(n=35)。PFNA组行PFNA治疗,ALP组行ALP治疗。比较2组术中情况、手术效果、术后恢复情况及手术前后骨代谢指标[I型前胶原基端前肽(PINP)及血清I型胶原C端肽(CTX)]水平变化,观察2组患者并发症发生情况。结果PFNA组手术时间、术中出血量、术中引流量、切口长度、住院时间、下地活动时间及骨折愈合时间分别为(56.21±5.42)min、(96.62±9.35)mL、(25.28±2.58)mL、(6.35±1.24)cm、(10.02±0.51)d、(7.31±0.72)d、(8.68±0.85)周,均显著优于ALP组[(98.41±8.25)min、(145.12±8.54)mL、(56.42±5.63)mL、(15.53±1.45)cm、(15.31±1.22)d、(8.94±0.83)d、(13.16±1.32)周],差异均有统计学意义(P<0.05)。2组患者Harris评分优良率比较(80.00%vs.77.14%),差异无统计学意义(P>0.05)。手术后,PFNA组PINP水平高于ALP组[(85.73±8.46)ng/mL vs.(75.12±5.48)ng/mL],CTX低于ALP组[(486.16±44.22)ng/L vs.(520.29±51.28)ng/L],差异均有统计学意义(P<0.05)。PFNA组并发症发生率显著低于ALP组(5.71%vs.22.86%),差异有统计学意义(P<0.05)。结论PFNA与ALP治疗老年股骨粗隆间骨折均有较好的效果,但PFNA能更有效改善患者术中情况及术后功能恢复情况,减少并发症的发生。

Objective To compare the curative effect of proximal femoral nail anti-rotation(PFNA)and anatomic proximal femoral locking plate(ALP)on elderly patients with femoral intertrochanteric fractures.Methods A total of 70 patients with femoral intertrochanteric fractures who were admitted to Xinhua Hospital of Huainan City from February 2016 to April 2019 were enrolled.According to random number table method,they were divide them into PFNA group(n=35)and ALP group(n=35).The intraoperative situations,surgical effect,postoperative recovery,and changes in levels of bone metabolism indexes[N-terminal peptide of type I collagen(PINP),serum C-terminal cross-linking telope ptides of type I collagen(CTX)]before and after surgery were compared between the two groups.The occurrence of complications in both groups was observed.Results The operation time,intraoperative blood loss,Intraoperative drainage volume,incision length,hospitalization time,leaving bed time and fracture healing time in PFNA group were(56.21±5.42)min,(96.62±9.35)mL,(25.28±2.58)mL,respectively,(6.35±1.24)cm,(10.02±0.51)d,(7.31±0.72)d,(8.68±0.85)weeks,which were significantly better than the ALP group[(98.41±8.25)min,(145.12±8.54)mL,(56.42±5.63)mL,(15.53±1.45)cm,(15.31±1.22)d,(8.94±0.83)d,(13.16±1.32)week],the differences were statistically significant(P<0.05).There was no significant difference in good rate of Harris scores between the two groups(80.00%vs.77.14%,P>0.05).After treatment,the levels of PINP in PFNA group was higher than that in the ALP group[(85.73±8.46)ng/mL vs.(75.12±5.48)ng/mL],and CTX in PFNA group was lower than than those in ALP group[(486.16±44.22)ng/L vs.(520.29±51.28)ng/L],the differences were statistically significant(P<0.05).The incidence of complications in PFNA group was significantly lower than that in ALP group(5.71%vs.22.86%,P<0.05).Conclusion The curative effect of both PFNA and ALP is good on elderly patients with femoral intertrochanteric fractures.However,PFNA can more effectively improve intraoperative situations and postoperative function recovery,and reduce the occurrence of complications.