股骨近端防旋髓内钉与解剖型锁定钢板内固定术治疗股骨粗隆间骨折患者的效果比较

Comparison of effects of proximal femoral anti-rotation intramedullary nail and anatomical locking plate internal fixation in treatment of patients with femoral intertrochanteric fractures

目的:比较股骨近端防旋髓内钉(PFNA)与股骨近端解剖型锁定钢板(ALP)内固定术治疗股骨粗隆间骨折患者的效果。方法:回顾性分析2019年3月至2021年6月该院收治的80例股骨粗隆间骨折患者的临床资料,依据术式不同分为PFNA组48例(行PFNA内固定术治疗)和ALP组32例(行ALP内固定术治疗)。比较两组围术期指标水平、髋关节功能优良率、治疗前后骨代谢指标[Ⅰ型前胶原氨基端前肽(PINP)、Ⅰ型胶原羧基末端肽(CTX)]水平,以及并发症发生率。结果:PFNA组手术时间、手术切口长度、下床活动时间和住院时间均短于ALP组,术中失血量、术后引流量均少于ALP组,差异有统计学意义(P<0.05);两组髋关节功能优良率比较,差异无统计学意义(P>0.05);术后,两组血清PINP水平均高于术前,且PFNA组高于ALP组,两组CTX水平均低于术前,且PFNA组低于ALP组,差异有统计学意义(P<0.05);PFNA组并发症发生率为2.08%(1/48),低于ALP组的25.00%(8/32),差异有统计学意义(P<0.05)。结论:PFNA与ALP内固定术均可有效恢复患者髋关节功能,但PFNA创伤更小,有助于改善骨代谢水平,降低并发症发生率。

Objective:To compare effects of proximal femoral anti-rotation intramedullary nail(PFNA)and anatomical locking plate(ALP)internal fixation in treatment of patients with femoral intertrochanteric fractures.Methods:The clinical data of 80 patients with femoral intertrochanteric fractures treated in this hospital from March 2019 to June 2021 were retrospectively analyzed,and they were divided into PFNA group(48 cases,treated with PFNA internal fixation)and ALP group(32 cases were treated with ALP internal fixation).The levels of perioperative indexes,the excellent and good rate of hip function,the bone metabolism index levels[procollagen I amino terminal propeptide(PINP)and type I collagen carboxy-terminal peptide(CTX)]before and after the treatment,and the incidence of complications were compared between the two groups.Results:The operation time,the surgical incision length,the ambulation time,and the hospitalization time in the PFNA group were shorter than those in the ALP group;the intraoperative blood loss and the postoperative drainage were less than those in the ALP group;the differences were statistically significant(P<0.05).There was no significant difference in the excellent and good rate of hip function between the two groups(P>0.05).After the surgery,the serum PINP levels in the two groups were higher than those before the surgery,and that of the PFNA group was higher than that of the ALP group;the CTX levels in the two groups were lower than those before the surgery,and that of the PFNA group was lower than that of the ALP group;and the differences were statistically significant(P<0.05).Further,the incidence of complications in PFNA group was 2.08%(1/48),which was lower than 25.00%(8/32)inA LP group,and the difference was statistically significant(P<0.05).Conclusions:Both PFNA and ALP internal fixation can effectively restore the hip joint function of the patients after the surgery,but PFNA is less traumatic and can help to improve the bone metabolism and reduce the incidence of complications.