股骨偏心距对股骨近端防旋髓内钉治疗股骨转子区骨折影响的研究

Effect of femoral offset on proximal femoral anti rotation intramedullary nail in the treatment of femoral trochanteric fractures

目的:探讨股骨偏心距(femoral offset,FO)对股骨转子区骨折股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)术后功能结果的影响。方法:2017年5月至2019年6月接受PFNA的112例患者进行分析,术前均行双髋X线及CT检查明确诊断,术后第1天均行骨盆双髋X线复查,其中71例患者正位X线片示双侧FO差值≤5 mm(A组),41例位患者示双侧FO差值>5 mm(B组)。两组患者性别、年龄、术侧、病程、术前髋关节Harris评分、术前患侧FO等一般资料比较,差异均无统计学意义(P>0.05),比较两组第6、12个月时髋关节Harris评分。对FO差值与Harris评分进行相关性分析。结果:两组患者术后随访12个月,骨折均达到愈合标准,术后第6、12个月两组髋关节Harris评分差异有统计学意义(P<0.05),术后双侧FO差值与第6、12个月时髋关节Harris评分存在负相关关系(R=-0.213,P<0.05),(R=-0.335,P<0.05)。结论:PFNA治疗转子区骨折中,术后双侧FO差值越大,患者术后功能越差,适宜的FO(双侧FO差值≤5 mm)可使得患者术后获得更好功能。

Objective:To investigate the effect of femoral offset(FO)on the postoperative functional results of proximal femoral nail antirotation(PFNA)in femoral trochanteric fractures.Methods:From May 2017 to June 2019,112 patients receiving PFNA were analyzed,X-ray and CT examination of both hips were performed before operation,and X-ray examination of both hips of pelvis was performed on the first day after operation.Among them,71 patients showed bilateral FO difference≤5 mm on positive X-ray film(group A),and 41 patients showed bilateral FO difference>5 mm(group B).There was no significant difference between two groups in gender,age,operative side,course of disease,Harris score of preoperative hip joint,preoperative FO(P>0.05).The Harris score of hip joint at 6 and 12 months was compared between two groups.The correlation between FO difference and Harris score was analyzed.Results:Patients in both groups were followed up for 12 months after surgery,and all patients reached the healing criteria.The difference of Harris score of the hip joint at 6 and 12 months after surgery was statistically significant(P<0.05),and the difference of bilateral FO was negatively correlated with the Harris score of the hip joint at 6 and 12 months after surgery(R=-0.213,P<0.05),(R=-0.335,P<0.05).Conclusion:In the treatment of trochanteric fractures with PFNA,the greater the difference of FO between the two sides,the worse the postoperative function of the patients.The appropriate FO(the difference of FO between the two sides≤5 mm)can improve the postoperative function of the patients.