3种内固定治疗老年骨质疏松性股骨转子间骨折的疗效比较

Comparison efficacy of three kinds of internal fixation in the treatment of osteoporotic femoral intertrochanteric fractures in the elderly

目的比较股骨近端防旋髓内钉(PFNA)、亚洲型股骨近端防旋髓内钉(APFNA)、联合加压交锁髓内钉(Inter Tan)3种内固定治疗老年骨质疏松性股骨转子间骨折的临床疗效。方法将69例老年骨质疏松性股骨转子间骨折患者按照内固定方法不同分为PFNA组(24例)、APFNA组(22例)和Inter Tan组(23例)。比较3组手术情况、术后并发症发生情况及术后恢复情况。采用Harris评分评价髋关节功能恢复情况。结果4例失访,其余患者均获得12个月随访。(1)手术情况:术中出血量、切口长度、手术时间PFNA组和APFNA组均明显少(短)于Inter Tan组(P<0.01)。(2)术后并发症发生率:Inter Tan组明显低于PFNA组和APFNA组(P<0.05)。(3)术后恢复情况:开始下地活动时间、开始负重时间、弃拐时间及骨折愈合时间Inter Tan组均明显短于PFNA组和APFNA组(P<0.05),PFNA组和APFNA组比较差异均无统计学意义(P>0.05)。(4)末次随访时Harris评分:3组比较差异无统计学意义(P>0.05)。结论PFNA内固定适用于手术耐受力差的老年患者;APFNA内固定适用于伴有重度骨质疏松的老年患者;Inter Tan内固定适用于手术耐受性较好,而又有较高活动能力要求的老年患者。

Objective To compare the clinical efficacy of three kinds of internal fixation:proximal femoral nail antirotation(PFNA),Asian type proximal femoral nail anti-rotation(APFNA)and combined compression interlocking intramedullary nail(Inter Tan)in the treatment of osteoporotic intertrochanteric fractures in the elderly.Methods Sixty-nine elderly patients were suffered from the osteoporotic intertrochanteric femoral fractures,they were divided into PFNA group(24 cases),APFNA group(22 cases),and Inter Tan group(23 cases)according to different internal fixation method.The three groups were compared in terms of surgery situation,postoperative complications,postoperative recovery.Harris score was used to evaluate the functional recovery of the hip joint.Results Four cases were lost to follow-up,and the remaining patients received 12 months follow-up.(1)Surgery situation:intraoperative bleeding volume,incision length,and operative time in the PFNA and APFNA groups were significantly less(shorter)than those in the Inter Tan group(P<0.01).(2)Postoperative complication incidence rate:Inter Tan group was significantly lower than PFNA group and APFNA group(P<0.05).(3)Postoperative recovery situation:the time to start ground activities,the time to start weight-bearing,the time to abandon abduction and the fracture healing time in the Inter Tan group were significantly shorter than those in the PFNA and APFNA groups(P<0.05),and the differences were not statistically significant between the PFNA and APFNA groups(P>0.05).(4)Harris score at the last follow-up:the difference was not statistically significant among the three groups(P>0.05).Conclusions PFNA internal fixation is suitable for elderly patients with poor surgical tolerance;APFNA internal fixation is suitable for elderly patients with severe osteoporosis;Inter Tan is suitable for patients with good surgical tolerance and high mobility requirements.