PFNA与InterTan治疗老年股骨转子间骨折的临床效果比较

Comparison of the clinical effect of PFNA and InterTan in the treatment of osteoporotic intertrochanteric fracture in the elderly

目的比较股骨近端防旋髓内钉(PFNA)与InterTan治疗老年股骨转子间骨折的临床效果。方法回顾性分析2017年1月~2018年8月南通大学附属南京江北医院骨科中心符合标准的147例老年(≥65岁)股骨转子间骨折患者的临床资料,其中采用PFNA治疗的75例,采用InterTan治疗的72例。比较两组患者的一般资料(年龄、基础疾病、骨折分型等)、临床资料(手术时间、术中出血量、术中透视次数等)、髋关节并发症(再次骨折、髋内翻等)、内固定相关并发症(如头钉切割、内固定断裂、松动等)及髋关节Harris评分。结果两组患者均顺利手术,均获得随访12~18个月,平均随访(13.54±1.68)个月。在术中出血量、术中透视次数、手术时间、开始负重时间、住院时间、骨折愈合时间及围手术期并发症方面,两组差异无统计学意义(P>0.05);两组在髋关节及内固定相关并发症方面差异无统计学意义(P>0.05),但PFNA组发生率明显高于InterTan组;术后随访1、3、6及12个月髋关节Harris评分,两组差异无统计学意义(P>>0.05),但InterTan组Harris评分高于PFNA组。结论两组治疗老年股骨转子间骨折都具有比较好的疗效,均具有手术时间短、术中出血量少、生物力学优势及稳定性的优点,但InterTan术后髋关节及内固定并发症的发生率低及术后髋关节功能恢复良好。

Objective To compare the clinical effect of proximal femoral nail antirotation(PFNA)and InterTan in the treatment of osteoporotic intertrochanteric fracture in the elderly.Methods A retrospective study was conducted on 147 patients who were old equal to or more than 65 years with femoral intertrochanteric fracture from January 2017 to August2018 Department of Orthopedics,the Affiliated Nanjing Jiangbei Hospital of Nantong University.Based on surgical methods,the patients were divided into the PFNA group(75 cases)and the InterTan group(72 cases).General information(age,basic diseases,fracture classification,etc.),clinical data(operation time,intraoperative blood loss,intraoperative fluoroscopy times,etc.),joint complications(refracture,coxa vara,etc.),internal fixation-related complications(head screw cutting,internal fixation fracture,loosening,etc.)and hip joint Harris score were compared between the two groups.Results All the patients in both groups had operation performed smoothly.The patients in both groups were followed up for 12-18 months,with an average of(13.54±1.68)months.In terms of intraoperative blood loss,intraoperative fluoroscopy times,operation time,loading time,hospital stay,fracture healing time and perioperative complications,there were no significant differences between the two groups(P>0.05).Although no statistically significant differences were noted regarding in complications related to hip joint and internal fixation between the two groups(P>0.05),the incidence of PFNA group was significantly higher than that of InterTan group.Despite of the facts that no significant differences were noticed in Harris scores of hip joint followed up for 1,3,6 and 12 months after surgery(P>0.05),the InterTan group had higher Harris score than the PFNA group.Conclusion Both groups had showed good efficacy in the treatment of elderly intertrochanteric fracture,which had the advantages of short operation time,less intraoperative blood loss,biomechanical advantages and stability.However,the incidence of complications of hip joint and internal fixation after InterTan surgery is low,and the postoperative hip joint function recovers well.