股骨近端防旋髓内钉与解剖锁定钢板治疗股骨粗隆间骨折的效果评价

Proximal femoral nail antirotation and anatomical locking plate in the treatment of intertrochanteric fractures

目的比较股骨近端防旋髓内钉(PFNA)与解剖锁定钢板两种方法治疗股骨粗隆间骨折患者的效果。方法选取2017年9月至2019年10月国药同煤三医院骨科收治的74例股骨粗隆间骨折患者,男40例,女34例,年龄(58.14±3.28)岁,年龄范围为48~76岁。依据治疗方法不同将患者分为解剖锁定钢板组和PFNA组,每组37例。解剖锁定钢板组采用解剖锁定钢板方式治疗。PFNA组采用PFNA方式治疗。术后随访3个月,分析比较两组患者治疗前后的髋关节功能评分、生活质量评分、临床指标及并发症发生情况。结果治疗后3个月PFNA组患者的疼痛[(38.04±3.07)分]、功能[(40.46±3.23)分]、关节活动度[(3.17±0.42)分]、肢体畸形[(3.20±0.38)分]及总分[(85.27±3.15)分]均高于解剖锁定钢板组[(33.53±2.64)分、(35.86±2.71)分、(2.38±0.36)分、(2.65±0.42)分、(77.32±3.47)分];治疗后3个月PFNA组患者生活质量评分[(90.61±3.65)分]显著高于解剖锁定钢板组[(82.72±4.08)分];PFNA组患者的手术时间[(62.76±12.98)min]、住院时间[(14.60±2.16)d]、负重时间[(7.25±0.62)周]、骨愈合时间[(11.36±1.47)周]均短于解剖锁定钢板组[(88.41±14.35)min、(17.57±2.72)d、(8.57±0.74)周、(13.58±1.63)周],差异均有统计学意义(P<0.05)。PFNA组患者并发症发生率[2.7%(1/37)]显著低于解剖锁定钢板组[21.6%(8/37)],差异有统计学意义(P<0.05)。结论股骨粗隆间骨折患者采用解剖锁定钢板、PFNA治疗均能起到一定的效果,与解剖锁定钢板治疗方法比较,采用PFNA治疗能够促进患者髋关节功能恢复,改善患者临床治疗效果,治疗安全性较高,值得在临床上推广应用。

Objective:To compare the efficacy of Proximal femoral nail antirotation(PFNA)and anatomical locking plate in the treatment of intertrochanteric fractures.Methods:From September 2017 to October 2019,74 patients with intertrochanteric fracture who were admitted to the department of Orthopedics,the Third Hospital of Tongmei were selected,including 40 males and 34 females,aged(58.14±3.28)years old,and the age range was 48 to 76 years old.According to different treatment methods,patients were divided into the anatomical locking plate group and PFNA group,with 37 cases in each group.Dissecting locking plate was performed in the anatomical locking plate group.PFNA was performed in the PFNA group.After 3 months of follow-up,the hip function score,quality of life score,clinical indicators and complications of the two groups were compared before and after treatment.Results:After 3 months of treatment,pain[(38.04±3.07)points],function[(40.46±3.23)points],joint range of motion[(3.17±0.42)points],limb deformity[(3.20±0.38)points]and total scores[(85.27±3.15)points]in PFNA group were significantly higher than those in the anatomical locking plate group[(33.53±2.64)points,(35.86±2.71)points,(2.38±0.36)points,(2.65±0.42)points and(77.32±3.47)points];the quality of life score of PFNA group[(90.61±3.65)points]was significantly higher than that of anatomical locking plate group[(82.72±4.08)points];the operation time[(62.76±12.98)minutes],hospitalization time[(14.60±2.16)days],weight bearing time[(7.25±0.62)weeks],bone healing time[(11.36±1.47)weeks]in PFNA group were significantly shorter than those in the anatomical locking plate group[(88.41±14.35)minutes,(17.57±2.72)days,(8.57±0.74)weeks and(13.58±1.63)weeks],and the differences were statistically significant(P<0.05).The incidence of complications in the PFNA group[2.7%(1/37)]was significantly lower than that in the anatomical locking plate group[21.6%(8/37)],and the differences were statistically significant(P<0.05).Conclusion:PFNA and anatomical locking plate can play a certain therapeutic effect in patients with intertrochanteric fracture.Compared with the anatomical locking plate treatment,PFNA treatment can promote the recovery of hip joint function,improve the clinical treatment effect of patients,and has higher treatment safety,which is worthy of clinical application.