两种方法定位股骨近端防旋螺钉治疗股骨转子间骨折的效果对比研究

Comparative study on different positioning of proximal femur anti-rotation screws for treatment of femoral intertrochanteric fractures

目的比较三点定位和常规定位技术在植入防螺旋刀片治疗股骨转子骨折的疗效。方法收集我院从 2016 年 1 月至 2018 年 6 月,共 90 例股骨转子间骨折患者采用股骨近端抗旋髓内钉 (proximal femoral nail anti-rotation,PFNA) 手术治疗的临床资料。根据定位技术的不同,对所有患者进行分组:三点组和常规组,每组 45 例。所有患者均由同一组外科医师使用 PFNA 技术进行手术。收集的临床指标包括手术时间、植入抗螺旋刀片花费的时间、术中失血量、X 线暴露时间和顶尖距 (tip-apexdistance,TAD) 及末次随访 Harris 评分并进行统计分析。结果三点组的手术时间、螺旋刀片的植入时间及术中 X 线透视次数均明显短于常规组[(54.4±8.4) min vs.(66.2±12.3) min,P < 0.01;(4.5±1.8) min vs.(8.4±2.6) min,P < 0.01;(8.3±1.6) 次 vs.(13.8±2.5) 次,P < 0.01]。三点组的术中失血和 TAD 距离均较常规组减少,差异有统计学意义[(80.3±23.6) ml vs.(150.5±28.7) ml,P < 0.01;(16.3±1.6) mm vs.(20.8±3.3) mm,P < 0.01]。在 90 例患者中,有 80 例随访了 10~15 个月,平均 12 个月,其中 42 例属于三点治疗组,38 例属于常规治疗组。三点组均未在股骨头上发现螺旋刀片松动,而术后 1 个月,常规组有 2 例发生。但是,术后 6 个月两组之间的 Harris 评分相比差异无统计学意义 (P=0.723)。结论三点定位法应用于 PFNA 治疗股骨转子间骨折比常规定位法更快,更准确。

Objective To compare three-point positioning and conventional positioning in the treatment of femoral tuberosity fractures by anti-spiral blades.Methods From January 2016 to June 2018,90 patients with femoral intertrochanteric fractures were treated with proximal femoral anti-rotation intramedullary nails (PFNA).According to different positioning techniques,all patients were divided into the three-point group (n=45) and conventional group (n=45).All patients were operated by the same group of surgeons using PFNA.Indicators including operation time,placement of anti-spiral blades,intraoperative blood loss,X-ray exposure,tip-apexdistance (TAD) and Harris score were collected and analyzed.Results Operation time,placement time of anti-spiral blades and X-ray exposure of the three-point group were significantly shorter than those of the conventional group[(54.4±8.4) min vs.(66.2±12.3) min,P < 0.01;(4.5±1.8) min vs.(8.4±2.6) min,P < 0.01;(8.3±1.6) vs.(13.8±2.5),P < 0.01].Intraoperative blood loss and tip-apexdistance (TAD) of the three-point group were reduced compared with the conventional group,and the differences were statistically significant[(80.3±23.6) ml vs.(150.5±28.7) ml,P < 0.01;(16.3±1.6) mm vs.(20.8±3.3) mm,P < 0.01].Among the 90 patients,80 patients were followed up for an average of 12 months (range:10-15 months),of which 42 patients belonged to the three-point treatment group and 38 patients belonged to the conventional treatment group.No loosening of the spiral blade was found in the three-point group,while 2 cases in the conventional group 1 month after surgery.Harris scores between the two groups were not statistically significant 6 months after surgery (P=0.723).Conclusions Three-point positioning is fast and accurate compared with conventional positioning methods in the treatment of femoral intertrochanteric fractures.