组配式环锯辅助股骨近端防旋髓内钉固定股骨转子间骨折

Assembled trephine assisted proximal femoral nail anti-rotation for fixation of femoral intertrochanteric fractures

[目的]探讨组配式环锯辅助下股骨近端防旋髓内钉(PFNA)内固定治疗股骨转子间骨折的临床效果。[方法]回顾性分析2018年1月-2020年4月在本院接受PFNA内固定治疗的70例股骨转子间骨折患者资料。其中,34例采用组配式环锯辅助PFNA内固定,36例采用常规标准配套工具PFNA置钉。比较两组围手术期、随访与影像资料。[结果]两组患者均顺利手术,术中均无严重并发症。术后第4 d和第11 d环锯组和常规组各有1例患者死于肺动脉栓塞。环锯组手术时间[(39.59±6.52)min vs(43.86±9.34)min,P<0.05]、术中透视次数[(11.39±2.66)次vs(14.66±1.97)次,P<0.05]均显著优于常规组。两组共68例患者随访12个月以上。两组患者下地行走和完全负重活动时间的差异无统计学意义(P>0.05),末次随访时,两组患者髋伸屈ROM、内-外旋ROM和内收-外展ROM,以及Harris评分的差异均无统计学意义(P>0.05)。影像方面,环锯组术后双侧颈干角差值[(4.25±1.49)°vs(5.16±2.05)°,P<0.05]和术后双侧偏心距差值[(3.19±1.58)mm vs(4.01±1.60)mm,P<0.05]均显著小于常规组;环锯组术后骨折复位质量显著优于常规组(P<0.05)。至未次随访时,两组患者均达至骨性愈合,两组骨折愈合时间的差异无统计学意义(P>0.05)。[结论]组配式环锯辅助转子间骨折PFNA内固定可显著提高手术效率和骨折复位质量。

[Objective]To explore the clinical outcomes of assembled trephine assisted proximal femoral nail anti-rotation(PFNA)for fixation of femoral intertrochanteric fractures.[Methods]From January 2018 to April 2020,a total of 70 patients received closed reduction and internal fixation with PFNA for femoral intertrochanteric fractures in our hospital.Among them,34 patients underwent assembled trephine assisted PFNA,while the remaining 36 patients received conventionally instrumented PFNA.The patients in the two groups were compared regarding perioperative period,follow-up and imaging documents.[Results]The patients in both groups were operated smoothly without serious complications during the operation.One patient in each group died of pulmonary embolism at the 4 thand 11 thday after operation.The trephine group proved significantly superior to the conventional group in terms of operation time[(39.59±6.52)min vs(43.86±9.34)min,P<0.05],and the number of intraoperative fluoroscopy[(11.39±2.66)times vs(14.66±1.97)times,P<0.05].A total of 68 patients in the two groups were followed up for more than 12 months.There were no statistically significant differences between the two groups regarding to the time to return walking and full weight-bearing activities(P>0.05).At the latest follow-up,there were no statistically significant differences in extension-flexion,internal-external rotation and adduction-abduction ROMs,and Harris scores between the two groups(P>0.05).With regard to radiographic assessment,the trephine group was significantly superior to the conventional group in terms of bilateral differences of neck-shaft angle[(4.25±1.49)°vs(5.16±2.05)°,P<0.05],and femoral head offset[(3.19±1.58)mm vs(4.01±1.60)mm,P<0.05].In addition,the trephine group got significantly better quality of fracture reduction than the conventional group(P<0.05).To the last follow-up,fracture healing had achieved in all patients of both groups,without a statistically significant difference in fracture healing time between the two groups(P>0.05).[Conclusion]This assembled trephine assisted PFNA internal fixation of intertrochanteric fractures does considerably improve the efficiency of surgical operation and the quality of fracture reduction.