股骨粗隆间骨折内侧皮质复位状态对骨折预后的影响

The Efficacy of Medial Cortical Reduction on the Prognosis of Intertrochanteric Fractures

目的:观察股骨粗隆间骨折内侧皮质不同复位结果下,股骨近端防旋髓内钉(PFNA)治疗粗隆间骨折的临床效果。方法:回顾性分析2018年7月至2020年2月,采用股骨近端防旋髓内钉内固定治疗股骨粗隆间骨折的老年患者87例,依据其内侧皮质的复位结果,将其分为阳性支撑组、中性支撑组及阴性支撑组。随访患者髋关节功能及骨折愈合时间、内固定失效情况。结果:阴性支撑组患者中5例患者出现内固定失效,不良事件发生率高于另外两组,差异有统计学意义(P<0.05);阴性支撑组患者骨折愈合时间最长,差异有统计学意义(P<0.05);术后8周、12周、24周、48周阴性支撑组患者髋关节功能较另外两组差,差异有统计学意义(P<0.05)。结论:在内侧皮质阴性支撑复位条件下,植入股骨近端防旋髓内钉失败概率较高,髋关节功能优良率较低。

Objective:To observe the clinical efficacy of intertrochanteric fractures treated with proximal femoral nail anti rotation(PFNA)under the condition of different reduction results of medial cortex.Methods:A retrospective analysis was performed on 87 elderly patients with intertrochanteric fractures who treated with PFNA internal fixation from July 2018 to February 2020.According to the reduction results of their medial cortex,they were divided into three groups:positive support group,neutral support group and negative support group.The hip function,fracture healing time and internal fixation failure were followed up.Results:Among the three groups,internal fixation failure occurred in 5 patients in the negative support group,and the incidence of adverse events was higher than that in the other two groups(P<0.05).The fracture healing time in the negative support group was the longest(P<0.05).In addition,the function of hip joint at 8,12,24 and 48 weeks after surgery was worse than that of the other two groups(P<0.05).Conclusion:Under the condition of negative medial cortex support reduction,the failure probability of PFNA implantation is high,and the excellent and good rate of hip joint function is low.