两种方式辅助PFNA在老年不稳定股骨粗隆间骨折中的应用研究

Comparative study with two ways of assisting proximal femoral nail antirotation in the treatment of unstable femoral tuberosity fractures in the elderly

目的探讨重建股骨矩联合股骨近端防旋髓内钉术(PFNA)与骨钩辅助PFNA在治疗老年不稳定股骨粗隆间骨折的临床效果。方法选取2015年1月—2019年1月江苏省南通市通州区人民医院住院治疗的老年不稳定股骨粗隆骨折患者52例,按照入院先后用数字编码将研究对象分为观察组和对照组,每组26例,观察组行重建股骨矩联合PFNA治疗,对照组行骨钩辅助PFNA治疗。比较两组手术时间、术中出血量、Harris评分、术后并发症发生情况。两组均随访12个月。结果观察组手术时间、出血量高于对照组,差异有统计学意义(P<0.05);观察组下地时间短于对照组,差异有统计学意义(P<0.05);观察组术后Harris评分高于对照组,差异有统计学意义(P<0.05);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论重建股骨矩联合PFNA与骨钩辅助PFNA均能够获得较好的临床效果,能够避免单一PFNA存在的不足。重建股骨矩联合PFNA能够获得更佳的稳定性,功能恢复也更优;骨钩辅助PFNA手术时间短、出血量少,手术操作难度以及创伤更小。健康状况较好,获得正常活动能力意愿较强的难复型股骨粗隆间骨折患者可以优先考虑重建股骨矩联合PFNA手术方案。

Objective To investigate the clinical effect of reconstruction of femoral moment combined with proximal femoral nail antirotation(PFNA)and bone hook assisted PFNA in the treatment of senile unstable femoral tuberosity fracture.Methods Fifty-two elderly patients with unstable trochanteric fracture who were hospitalized in Nantong Tongzhou People’s Hospital,Jiangsu Province from January 2015 to January 2019 were selected,the subjects were divided into observation group and control group by digital coding according to admission sequence,with 26 cases in each group,the observation group were treated with reconstructed femoral moment combined with PFNA treatment,the control group were treated with bone hook to assist PFNA treatment.The operation time,intraoperative blood loss,Harris score,and postoperative complications of the two groups were compared.Both groups were followed up for 12 months.Results The operation time and bleeding volume of the control group were higher than that of the control group,the differences were statistically significant(P<0.05);start time of postoperative exercise was shorter than the observation group,the difference was statistically significant(P<0.05);the postoperative Harris score of the observation group was higher than that of the control group,the difference was statistically significant(P<0.05);there was no statistically significant difference in the incidence of complications between the two groups(P>0.05).Conclusion Reconstruction of femoral moment combined with PFNA and bone hook-assisted PFNA can obtain good clinical results,avoid single PFNA defects,and achieve the role of repair,reconstruction and stability of lateral wall integrity.Reconstruction of femoral moment combined with PFNA can obtain better stability and better functional recovery;the operation time of bone hook assisted PFNA is short,the amount of bleeding is less,the operation is difficult and the trauma is less.Patients with better health and strong willingness to obtain normal mobility can give priority to the reconstruction of femoral moment combined with PFNA surgery.