髓内钉联合重建钢板治疗伴外侧壁损伤的股骨粗隆间骨折的临床研究

Clinical Study of Intramedullary Nail Combined with Reconstruction Plate in the Treatment of Intertrochanteric Fracture with Lateral Wall Injury

目的:比较髓内钉联合重建钢板与单纯髓内钉固定治疗伴外侧壁损伤的股骨粗隆间骨折的临床效果。方法:回顾性分析2018年1月-2020年1月35例在本院行手术治疗的伴外侧壁损伤的股骨粗隆间骨折患者的临床资料。根据手术方式的不同,分为研究组(n=16)和对照组(n=19)。研究组采用髓内钉结合重建钢板,对照组采用单纯髓内钉固定。比较两组一般指标、手术相关指标、骨形成状态指标、功能结局指标。结果:研究组手术时间长于对照组,术中出血量多于对照组,骨折愈合时间短于对照组,差异均有统计学意义(P<0.05)。研究组并发症发生率为6.25%,低于对照组的31.58%,差异无统计学意义(P>0.05)。术前,两组BALP比较,差异无统计学意义(P>0.05);术后30 d,两组BALP均高于术前,且研究组高于对照组,差异均有统计学意义(P<0.05)。术前,两组HHS、PPMS比较,差异均无统计学意义(P>0.05);术后6、12个月,研究组HHS、PPMS均高于对照组,差异均有统计学意义(P<0.05)。结论:髓内钉联合重建钢板固定虽然手术时间较长,术中出血量较多,但在骨折愈合时间、并发症发生率、骨形成状态指标改善、术后功能恢复等方面优于单纯髓内钉固定。

Objective:To compare the clinical effect of intramedullary nail combined with reconstruction plate and simple intramedullary nail fixation in the treatment of intertrochanteric fracture with lateral wall injury.Method:Clinical data of 35 patients with intertrochanteric fracture with lateral wall injury who underwent surgical treatment in our hospital from January 2018 to January 2020 were retrospectively analyzed.According to different surgical methods,they were divided into study group (n=16) and control group (n=19).The study group was treated with intramedullary nail combined with reconstruction plate,and the control group was treated with simple intramedullary nail fixation.General indexes,operation-related indexes,bone formation status indexes and functional outcome indexes were compared between two groups.Result:The surgical time of the study group was longer than that of the control group,the amount of intraoperative blood loss was more than that of the control group,and the time of fracture healing was shorter than that of the control group,the differences were statistically significant (P<0.05).The complication rate of the study group was 6.25%,which was lower than 31.58% of the control group,the difference was not statistically significant (P>0.05).Before surgery,there was no significant difference in BALP between two groups (P>0.05);at 30 d after surgery,BALP of both groups were higher than those before surgery,and that of the study group was higher than that of the control group,the differences were statistically significant (P<0.05).Before surgery,there were no significant differences in HHS and PPMS between two groups (P>0.05);at 6 and 12 months after surgery,HHS and PPMS of the study group were higher than those of the control group,the differences were statistically significant (P<0.05).Conclusion:Although the surgical time is longer and the intraoperative blood loss is more,intramedullary nail combined with reconstruction plate is superior than simple intramedullary nail fixation in fracture healing time,complication rate,improvement of bone formation status indicators,and postoperative functional recovery.