股骨近端防旋髓内钉近端滑动加压正性支撑复位治疗老年股骨转子间骨折

Proximal femoral nail antirotation and proximal sliding compression and positive support reduction in the treatment of intertrochanteric fractures in older adults

背景:股骨近端防旋髓内钉是目前治疗股骨转子间骨折的首选内固定物,非解剖复位时,选用不同类型的尾帽,可能会对手术疗效产生影响。目的:探讨近端滑动加压技术在使用股骨近端防旋髓内钉内固定治疗并获得正性支撑复位的老年股骨转子间骨折中的临床疗效。方法:回顾性分析2016年8月至2019年8月安徽医科大学第三附属医院(合肥市第一人民医院)创伤骨科应用股骨近端防旋髓内钉内固定治疗,并在术中获得正性支撑复位的76例老年股骨转子间骨折患者的临床资料,根据是否采用近端滑动加压技术分为2组,滑动加压组42例,近端均采用滑动加压技术;非滑动加压组34例,近端均采用常规治疗。比较两组患者的手术时间、术中出血量、术后即刻和术后6个月的股骨颈长度改变量、尖顶距改变量、骨折愈合时间、术后并发症发生率、术后1年随访髋关节Harris功能评分等。结果与结论:①两组患者的性别、年龄、侧别、致伤原因、骨折分型等一般资料比较,差异均无显著性意义(P>0.05),具有可比性;②两组患者的手术时间、术中出血量、术后即刻和术后6个月的股骨颈长度改变量、尖顶距改变量、术后并发症发生率、术后1年随访髋关节Harris功能评分等相比较,差异均无显著性意义(P>0.05);③但滑动加压组骨折愈合时间[(6.79±0.81)周]显著短于非滑动加压组[(7.88±1.07)周],差异有显著性意义(P<0.05);④提示应用股骨近端防旋髓内钉内固定治疗老年股骨转子间骨折,在无法解剖复位时,内侧皮质应力求达到正性支撑复位,近端采用滑动加压技术可显著缩短骨折愈合时间。

BACKGROUND:Proximal femoral antirotation intramedullary nailing is currently the preferred internal fixator for the treatment of intertrochanteric fractures of the femur.The use of different types of tail caps in non-anatomical reduction may have an impact on the surgical efficacy.OBJECTIVE:To investigate the clinical effect of proximal sliding compression technique in the treatment of elderly intertrochanteric fractures of the femur with proximal femoral nail antirotation internal fixation and positive supportive reduction.METHODS:Clinical data of 76 cases of elderly intertrochanteric fractures of the femur,who were treated in Department of Orthopedics and Traumatology,the Third Affiliated Hospital of Anhui Medical University(the First People’s Hospital)from August 2016 to August 2019 using proximal femoral nail antirotation treatment and positive support in intraoperative reduction,were retrospectively analyzed.The patients were divided into two groups according to the presence and absence of proximal sliding compression technology.The 42 cases in the sliding compression group received sliding compression technique at the proximal end.The 34 cases in the non-sliding pressure group received conventional treatment at the proximal end.Operation time,intraoperative blood loss,changes in femoral neck length immediately and 6 months after surgery,tip-apex distance change,fracture healing time,incidence of postoperative complications,and hip Harris function score were compared between the two groups at 1 year after surgery.RESULTS AND CONCLUSION:(1)There was no significant difference between the two groups in gender,age,side,cause of injury,fracture type and other general data(P>0.05),and the data of the two groups were comparable.(2)There were no significant differences between the sliding pressure group and the non-sliding pressure group in operation time,intraoperative blood loss,changes in femoral neck length immediately and 6 months after surgery,tip-apex distance change,postoperative complication rate,and hip joint Harris function score at 1 year after surgery(P>0.05).(3)However,the fracture healing time[(6.79±0.81)weeks]in the sliding pressure group was significantly shorter than that of the non-sliding pressure group[(7.88±1.07)weeks],with a significant difference(P<0.05).(4)It was suggested that proximal femoral nail antirotation internal fixation should be applied to the treatment of senile intertrochanteric fractures.When anatomical reduction cannot be achieved,the medial cortex should strive to achieve positive supportive reduction,and the proximal application of sliding compression technology can significantly shorten the fracture healing time.