普通型与骨水泥强化型股骨近端防旋髓内钉治疗老年股骨粗隆间骨折的对比研究

Comparative study of normal and cement-reinforced proximal femoral nail antirotation in treating femoral intertrochanteric fracture in elderly patients

目的:比较普通型与骨水泥强化型股骨近端防旋髓内钉(PFNA)治疗老年股骨粗隆间骨折的临床疗效。方法:回顾性分析徐州医科大学附属宿迁医院2018年1月至2019年9月收治的45例老年骨质疏松性股骨粗隆间骨折患者的临床资料。24例采用普通型PFNA内固定治疗(A组),男10例,女14例;年龄70~91岁,平均(80.2±5.7)岁;骨折Evens-Jensen分型:Ⅲ型12例,Ⅳ型9例,Ⅴ型3例。21例采用骨水泥强化型PFNA内固定治疗(B组),男8例,女13例;年龄72~94岁,平均(81.3±5.2)岁;骨折Evens-Jensen分型:Ⅲ型9例,Ⅳ型10例,Ⅴ型2例。记录并比较两组患者手术时间、术中出血量、术后住院时间、术后早期负重时间、骨折愈合时间、术后并发症发生率和Harris髋关节功能评分。结果:两组患者手术时间、术中出血量比较差异无统计学意义(P>0.05)。A组术后住院时间、术后早期负重时间、骨折愈合时间长于B组,差异有统计学意义(P<0.05)。A组发生肺部感染2例,褥疮1例,下肢深静脉血栓2例,螺旋刀片头、颈切出2例;B组发生切口感染1例。A组并发症发生率高于B组,差异有统计学意义(P<0.05)。术后3、6个月Harris髋关节功能评分B组优于A组,差异有统计学意义(P<0.05);但两组术后12个月的Harris评分比较差异无统计学意义(P>0.05)。结论:骨水泥强化型PFNA较普通型PFNA更适合于老年骨质疏松性股骨粗隆间骨折患者的治疗,术后住院时间更短,下床时间更早,骨折愈合时间更短,并发症更少,疗效显著。

Objective:To compare the clinical efficacy of normal and cement-reinforced proximal femoral nail antirotation(PFNA)in treating femoral intertrochanteric fracture in the elderly.Methods:A retrospective study was performed on 45 aged patients with osteoporosis who suffered from femoral intertrochanteric fracture from January 2018 to September 2019 in the Affiliated Suqian Hospital of Xuzhou Medical University.Of them,24 patients were treated with normal PFNA(group A),including 10 males and 14 females aged from 70 to 91 years with an average of(80.2±5.7)years.12 patients were marked as typeⅢ,9 as typeⅣ,and 3 as typeⅤaccording to Evens-Jensen classification.21 patients were treated with cement-reinforced PFNA(group B),including 8 males and 13 females aged from 72 to 94 years with an average of(81.3±5.2)years.9 patients were marked as typeⅢ,10 as typeⅣ,and 2 as typeⅤaccording to Evens-Jensen classification.The operative time,intraoperative blood loss,postoperative hospital stay,postoperative weight-bearing time,fracture healing time,postoperative complication rate,and Harris hip function score were recorded and compared between the two groups.Results:There was no significant difference between the two groups in operation time and intraoperative blood loss(P>0.05).The postoperative hospital stay,postoperative weight-bearing time and fracture healing time in group A were longer than those in group B,with statistically significant difference(P<0.05).Postoperative complications occurred in 7 patients in group A,including pulmonary infection in 2 patients,bedsore in 1 patient,deep vein thrombosis of the lower extremity in 2 patients,and spiral blade cutting out in 2 patients.One patient of incision infection occurred in group B.The complication rate in group A was higher than that in group B,and the difference was statistically significant(P<0.05).The Harris hip function scores of patients in group B were superior to those in group A at 3 and 6 months after surgery(P<0.05).However,there was no significant difference in Harris scores at 12 months after surgery between the two groups(P>0.05).Conclusion:Compared with normal PFNA,cement-reinforced PFNA is more suitable for the treatment of elderly patients with osteoporotic femoral intertrochanteric fracture,with shorter postoperative hospital stay,earlier postoperative weight-bearing time,shorter fracture healing time,fewer complications,and significant clinical efficacy.