两种内固定治疗老年不稳定型股骨转子间骨折的疗效比较

The effect comparison of two kinds of internal fixation for treatment of femoral intertrochanteric fracture

目的 比较髓内交锁固定系统(InterTAN髓内钉)与股骨近端防旋髓内钉(PFNA)治疗老年不稳定型股骨转子间骨折的疗效。方法 将148例老年不稳定型股骨转子间骨折患者根据内固定方式不同分为InterTAN组(采用InterTAN髓内钉治疗,72例)和PFNA组(采用PFNA治疗,76例)。比较两组手术情况,采用疼痛VAS评分、Harris评分评价术后疼痛缓解情况及髋关节功能恢复情况。结果 6例失访;142例获得随访,时间12~15个月。手术时间、术中出血量、住院时间:PFNA组均短(少)于InterTAN组(P<0.05)。两组骨折均愈合,骨折愈合时间两组比较差异均无统计学意义(P> 0.05)。疼痛VAS评分、 Harris评分:术后3、6个月InterTAN组均优于PFNA组(P<0.05),术后12个月两组比较差异均无统计学意义(P> 0.05)。术后并发症发生率InterTAN组低于PFNA组(P<0.05)。结论 InterTAN髓内钉与PFNA治疗老年不稳定型股骨转子间骨折均能获得较好的疗效。对于身体耐受差、合并症多、不能耐受长时间手术的患者,可以采用PFNA治疗;对于需要牢固固定、生活质量要求高的骨折疏松患者,可以采用InterTAN髓内钉治疗。

Objective To compare the efficacy of InterTAN intramedullary nail and proximal femoral anti-rotation nail(PFNA) in the treatment of unstable femoral intertrochanteric fractures.Methods The 148 patients with unstable intertrochanteric fractures were divided into InterTAN group(InterTAN intramedullary nail fixation,72 cases) and PFNA group(PFNA fixation,76 cases). The surgery conditions was compared between two groups. Pain VAS and Harris score were used to evaluate the postoperative pain relief degree and hip joint function recovery situation.Results Six cases were lost to follow-up,142 cases were followed up for 12 ~ 15 months. The operative time,intraoperative blood loss and hospital stay in PFNA group were all shorter(less) than those in InterTAN group(P< 0. 05). All fractures healed in two groups, and there was no significant difference in the fracture healing time between the two groups(P> 0. 05). Pain VAS and Harris score: at 3,6 months after surgery,they were better in the InterTAN group than those in the PFNA group(P< 0. 05),but there were no significant differences between the two groups at 12months after surgery(P> 0. 05). The incidence rate of postoperative complications in InterTAN group was lower than that in PFNA group(P< 0. 05).Conclusions InterTAN intramedullary nail and PFNA fixation are effective in the treatment of elderly unstable intertrochanteric fractures. PFNA fixation can be used for patients with poor tolerance,many complications and intolerance to prolonged time surgery. InterTAN intramedullary nail fixation can be used for patients with osteoporosis who require firm fixation and high quality of life.