PFN和PFNA-2治疗骨质疏松性不稳定型股骨粗隆间骨折患者的临床疗效及预后比较

Comparison of clinical efficacy and prognosis of PFN and PFNA-2 in the treatment of patients with osteoporotic unstable intertrochanteric fracture

目的比较PFN和PFNA-2治疗骨质疏松性不稳定型股骨粗隆间骨折患者的临床疗效及预后。方法随机选取2017年5月~2020年5月辽宁省金秋医院骨科收治的骨质疏松性不稳定型股骨粗隆间骨折患者120例作为研究对象,随机分为PFN组和PFNA-2组,每组各60例。PFN组给予PFN内固定治疗,PFNA-2组给予PFNA-2内固定治疗,比较两组患者的围术期指标、并发症、髋功能、骨代谢指标和远期随访情况。结果PFNA-2组患者的术中失血量、手术时间及术后引流量均低于PFN组(均P<0.05),且并发症发生率低于PFN组(P<0.05),卧床时间及住院时间比较,差异无统计学意义(均P>0.05),术前两组患者的Harris评分、BALP、BGP和TRAP比较,差异无统计学意义(均P>0.05),两组术后1、6、12个月的Harris功能评分、BALP、BGP水平均高于术前,TRAP低于术前,差异均有统计学意义(均P<0.05);且PFNA-2组均优于同期PFN组(均P<0.05)。PFNA-2组骨折愈合时间和内固定周围骨折发生率低于PFN组(均P<0.05),手术失败率和二次手术率比较,差异无统计学意义(均P>0.05)。结论PFNA-2治疗骨质疏松性不稳定型股骨粗隆间骨折患者可降低手术创伤和并发症,促进髋骨功能恢复,临床疗效较优,值得临床推广。

Objective To observe and compare the clinical efficacy and prognosis of PFN and PFNA-2 in the treatment of patients with osteoporotic unstable intertrochanteric fracture.Methods A total of 120 patients with osteoporotic unstable femoral intertrochanteric fracture who were admitted to the Department of Orthopedics in Jinqiu Hospital of Liaoning Province from May 2017 to May 2020 were randomly selected as the research subjects and divided into the PFN group and the PFNA-2 group according to the random number table,with 60 cases in each group.The PFN group received PFN internal fixation,while the PFNA-2 group received PFNA-2 internal fixation.The perioperative indexes,complications,hip function,bone metabolism indexes and long-term follow-up were compared between the two groups.Results The intraoperative blood loss,operation time and postoperative drainage volume of the PFNA-2 group were lower than those of the PFN group(all P<0.05),and there was no significant difference in the bedridden time and hospital stay(all P>0.05).The complication rate in the PFNA-2 group was lower than that in the PFN group(P<0.05).There was no significant difference in preoperative Harris hip score,BALP,BGP and TRAP between the two groups(all P>0.05).The Harris hip score,BALP and BGP levels in the two groups at 1,6,and 12 months after the operation were higher than those before the operation,and TRAP was lower than that before the operation,with statistically significant differences(all P<0.05);Harris function score,BALP,BGP and TRAP in the PFNA-2 group before and after the operation were better than those in the PFN group(all P<0.05).The fracture healing time and the incidence of fractures around internal fixation in the PFNA-2 group were shorter than those in the PFN group(all P<0.05).There were no significant differences in the surgical failure rate and secondary surgery rate(both P<0.05).Conclusion PFNA-2 in the treatment of patients with osteoporotic unstable intertrochanteric fracture can reduce surgical trauma and complications,and promote the recovery of hip bone function.It has better clinical efficacy than PFN and is worthy of clinical promotion.