远端第四点固定因素在亚洲型防旋股骨近端髓内钉治疗老年骨质疏松性不稳定型股骨粗隆间骨折中的作用

Role of distal fourth point fixation factor in treatment of senile osteoporotic unstable femoral intertrochanteric fractures with PFNA-Ⅱintramedullary nail

目的评估远端的稳定在亚洲型防旋股骨近端髓内钉(PFNA-Ⅱ)治疗老年骨质疏松性不稳定型股骨粗隆间骨折中的作用。方法回顾性分析2018年5月至2020年5月唐山市第二医院和唐山市工人医院收治的110例老年骨质疏松性不稳定型股骨粗隆间骨折患者的临床资料。按照PFNA-Ⅱ主钉的长度,将患者分为短髓内钉组(54例,采用240 mm短髓内钉,确保三点固定)和长髓内钉组(56例,采用325 mm长髓内钉,确保四点固定)。比较2组患者的手术指标、并发症及随访指标情况。采用SPSS 25.0统计软件进行数据分析,根据数据类型,分别采用t检验或χ^(2)检验进行组间比较。结果长髓内钉组手术时间、术中出血量、住院时间与短髓内钉组比较,差异无统计学意义(P>0.05);长髓内钉组术中透视时间、并发症发生率、部分负重时间、完全负重时间、骨折愈合时间、恢复至术前行走能力的比例及股骨干再骨折率均优于短髓内钉组(P<0.05)。术后6个月、末次随访时长髓内钉组颈干角优于短髓内钉组[(103.53°±6.29°)和(90.37°±5.88°),(139.47°±6.5°)和(116.01°±6.52°)]、Harris评分优于短髓内钉组[(71.40±4.15)和(62.33±4.01)分,(85.79±4.81)和(74.98±4.58)分],差异均有统计学意义(P<0.05)。结论远端第四点固定因素可确保髓内钉固定治疗老年骨质疏松性不稳定型股骨粗隆间骨折时的四点固定,实现髓内钉整体的远端稳定。针对该类患者采用长髓内钉治疗效果优于短髓内钉,能够降低股骨干再骨折率。

Objective To evaluate the role of distal stabilization in the treatment of elderly osteoporotic unstable femoral intertrochanteric fractures with the Asian-type proximal femoral nail antirotation-Ⅱ(PFNA-Ⅱ).Methods A retrospective analysis was performed on the clinical data of 110 elderly patients with osteoporotic unstable femoral intertrochanteric fractures admitted to Tangshan Second Hospital and Tangshan Workers Hospital from May 2018 to May 2020.According to the length of implanted PFNA-Ⅱmain nail,the patients were divided into short intramedullary nail group(n=54,a nail of 240 mm in length to ensure 3-point fixation)and long intramedullary nail group(n=56,a nail of 325 mm to ensure 4-point fixation).The surgical indicators,incidence of complications and follow-up data were compared between the two groups.SPSS statistics 25.0 was used for data analysis,and the intergroup differences were compared with student′s t test or Chi-square test for different data types.Results There were no statistical differences in operation time,intraoperative bleeding loss and length of hospital stay between the two groups(P>0.05).Long intramedullary nail group showed better results in intraoperative fluoroscopy time,complication incidence,partial weight-bearing time,full weight-bearing time,fracture healing time,proportion of recovery to preoperative walking ability,refracture rate of femoral shaft when compared with the short intramedullary nail group(P<0.05).At six months after operation and at the last follow-up,the neck-shaft angle[(103.53°±6.29°)vs(90.37°±5.88°),(139.47°±6.5°)vs(116.01°±6.52)°]and Harris score[(71.40±4.15)vs(62.33±4.01),(85.79±4.81)vs(74.98±4.58)]were better in the long than the short intramedullary nail group(P<0.05).Conclusion The fourth point distal fixation factor can ensure the 4-point fixation of intramedullary nail fixation in the treatment of elderly osteoporotic unstable intertrochanteric fractures,and achieve the overall distal stability of the intramedullary nail.For these patients,the treatment effect of long intramedullary nails is better than that of short nails,which can reduce the refracture rate of the femoral shaft.