股骨近端防旋髓内钉内固定与股骨近端锁定钢板内固定治疗A2.3型股骨转子间骨折合并大转子外侧壁冠状面破损的对比研究

A comparative study of internal fixation with proximal femoral nail antirotation versus proximal femoral loc-king plate for treatment of type A2.3 femoral intertrochanteric fractures combined with greater trochanteric lateral wall coronal fractures

目的:比较股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定与股骨近端锁定钢板(proximal femoral locking plate,PFLP)内固定治疗A2.3型股骨转子间骨折合并大转子外侧壁冠状面破损的临床疗效。方法:回顾性分析2013年5月至2019年8月收治的65例A2.3型股骨转子间骨折合并大转子外侧壁冠状面破损患者的病例资料。37例采用PFNA内固定治疗(PFNA组),28例采用PFLP内固定治疗(PFLP组)。比较2组患者的手术切口长度、手术时间、术中出血量、术后开始负重时间、骨折愈合时间及Harris髋关节评分。结果:①一般指标。PFNA组患者手术切口长度、术中出血量均小于PFLP组[(8.05±1.75)cm,(15.05±6.36)cm,t=15.254,P=0.000;(124.50±8.50)mL,(315.50±6.50)mL,t=76.652,P=0.000],手术时间、术后开始负重时间、骨折愈合时间均短于PFLP组[(53.50±5.50)min,(74.50±7.60)min,t=27.652,P=0.000;(38.50±1.85)d,(64.50±3.35)d,t=30.746,P=0.000;(11.24±1.22)周,(14.06±1.53)周,t=1.620,P=0.026]。②Harris髋关节评分。时间因素和分组因素不存在交互效应(F=6.352,P=0.109);2组患者Harris髋关节评分总体比较,差异有统计学意义,即存在分组效应(F=5.214,P=0.038);术后不同时间点之间Harris髋关节评分的差异有统计学意义,即存在时间效应(F=6.836,P=0.016);2组患者Harris髋关节评分随时间延长均呈逐渐升高趋势,且2组的升高趋势一致[(67.45±4.30)分,(80.35±3.00)分,(88.65±4.20)分,F=4.251,P=0.041;(56.26±2.40)分,(68.25±4.60)分,(78.37±3.30)分,F=7.528,P=0.012];术后3个月、6个月、12个月,PFNA组的Harris髋关节评分均高于PFLP组(t=1.763,P=0.031;t=1.635,P=0.035;t=1.586,P=0.046)。结论:PFNA内固定与PFLP内固定治疗A2.3型股骨转子间骨折合并大转子外侧壁冠状面破损,均能促进髋关节功能恢复,但前者创伤小、骨折愈合快,患者术后可以较早开始负重。

Objective:To compare the clinical curative effects of internal fixation with proximal femoral nail antirotation(PFNA)versus proximal femoral locking plate(PFLP)in treatment of type A2.3 femoral intertrochanteric fractures combined with greater trochanteric later-al wall coronal fractures.Methods:The medical records of 65 patients with type A2.3 femoral intertrochanteric fractures and greater tro-chanteric lateral wall coronal fractures recruited from May 2013 to August 2019 were analyzed retrospectively.Thirty-seven patients were treated with PFNA internal fixation(PFNA group),while the others were treated with PFLP internal fixation(PFLP group).The incision length,operative time,intraoperative blood loss,postoperative weight-bearing walking start time,fracture healing time and Harris hip scores were compared between the 2 groups.Results:The operative incision was smaller,the intraoperative blood loss was less and the operative time,postoperative weight-bearing walking start time and fracture healing time were shorter in PFNA group compared to PFLP group(8.05±1.75 vs 15.05±6.36 cm,t=15.254,P=0.000;124.50±8.50 vs 315.50±6.50 mL,t=76.652,P=0.000;53.50±5.50 vs 74.50±7.60 minutes,t=27.652,P=0.000;38.50±1.85 vs 64.50±3.35 days,t=30.746,P=0.000;11.24±1.22 vs 14.06±1.53 weeks,t=1.620,P=0.026).There was no interaction between time factor and group factor in Harris hip scores(F=6.352,P=0.109).There was statistical difference in Harris hip scores between the 2 groups in general,in other words,there was group effect(F=5.214,P=0.038).There was statistical difference in Harris hip scores between different timepoints after the surgery,in other words,there was time effect(F=6.836,P=0.016).The Harris hip scores presented a time-dependent increasing trend in the 2 groups,while both were con-sistent with each other in the variation tendency(67.45±4.30,80.35±3.00,88.65±4.20 points,F=4.251,P=0.041;56.26±2.40,68.25±4.60,78.37±3.30 points,F=7.528,P=0.012).The Harris hip scores were higher in PFNA group compared to PFLP group at 3,6 and 12 months after the surgery(t=1.763,P=0.031;t=1.635,P=0.035;t=1.586,P=0.046).Conclusion:Both PFNA and PFLP internal fixation can promote hip function recovery in treatment of type A2.3 femoral intertrochanteric fractures combined with greater trochanteric lateral wall coronal fractures,however,the former has such advantages as less injuries,faster fracture healing and postoperative earlier weight-bearing compared to the latter.