3种内固定治疗骨质疏松性股骨转子间骨折的疗效比较

Effect comparison of three kinds of internal fixation in the treatment of osteoporotic intertrochanteric fracture

目的比较InterTan髓内钉、股骨近端防旋髓内钉(PFNA)、Gamma钉治疗骨质疏松性股骨转子间骨折的疗效。方法将48例骨质疏松性股骨转子间骨折患者根据内固定方式不同分为InterTan组、PFNA组和Gamma钉组,每组16例。比较3组手术情况、术后并发症以及髋关节功能恢复情况。结果患者均获得随访,时间18~28个月。切口长度、手术时间、术中出血量、术中透视次数、首次下床负重时间、骨痂形成时间、骨折愈合时间InterTan组和PFNA组均优于Gamma钉组(P<0.05),切口长度、首次下床负重时间、骨痂形成时间、骨折愈合时间InterTan组均短(早)于PFNA组(P<0.05)。术后并发症发生率InterTan组和PFNA组均低于Gamma钉组(P<0.05);术后12个月髋关节功能优良率InterTan组和PFNA组均高于Gamma钉组(P<0.05);以上2项指标InterTan组和PFNA组比较差异均无统计学意义(P>0.05)。结论3种内固定均可有效治疗骨质疏松性股骨转子间骨折,但是InterTan髓内钉固定具有切口小、首次下床负重时间早、骨折愈合时间短的优点。

Objective To investigate the therapeutic effect of InterTan intramedullary nail,proximal femoral nail antirotation(PFNA)and Gamma nail in the treatment of osteoporotic intertrochanteric fracture.Methods Forty-eight patients with osteoporotic intertrochanteric fractures were divided into InterTan group,PFNA group and Gamma nail group,according to different internal fixation methods,with 16 cases in each group.The surgery situation,postoperative complications and the recovery situation of the hip function were compared among three groups.Results All cases were followed up for 18~28 months.The incision length,operation time,intraoperative blood loss,X-ray fluoroscopy times,the first leaving bed and weight-bearing time,callus formation time and fracture healing time in the InterTan group and PFNA group were better than those in the Gamma nail group(P<0.05),and the incision length,the first leaving bed and weight-bearing time,callus formation time and fracture healing time in the InterTan group were all shorter(earlier)than those of the PFNA group(P<0.05).The incidence rate of postoperative complications in the InterTan group and PFNA group were both lower than that of Gamma group(P<0.05).At 12 months postoperation,the excellent-good rate of hip function in the InterTan group and PFNA group was both higher than that of Gamma group(P<0.05).For above two indicators,there were no differences between the InterTan group and PFNA group(P>0.05).Conclusions Three kinds of internal fixation can effectively treat osteoporotic femoral intertrochanteric fracture,but InterTan intramedullary nail internal fixation has the advantages of small incision,early first weight-bearing time after leaving bed and shorter fracture healing time.