加长PFNA联合MIPPO钢板重建外侧壁治疗AO-A3.3型股骨转子间骨折的疗效分析

Clinical analysis of extended PFNA combined with MIPPO plate for reconstruction of lateral wall in treatment of AO-A3.3 intertrochanteric fracture

目的:比较加长型股骨近端带螺旋刀片髓内钉(proximal femoral nail anti-rotation,PFNA)联合微创经皮钢板固定技术(minimally invasive percutaneous plate osteosynthesis,MIPPO)与普通PFNA治疗AO-A3.3型转子间骨折的临床疗效。方法:对2015年1月至2020年4月收治的58例AO-A3.3型股骨转子间骨折患者临床资料进行回顾分析,其中27例采用加长PFNA+MIPPO钢板重建外侧壁(A组),31例采用闭合复位PFNA固定(B组)。观察比较两组患者术中出血量,手术时间,术后2 d、6个月股骨颈长度和顶尖距(tip apex distance,TAD),骨折愈合时间,术后并发症。术后10个月采用Harris评分对髋关节功能进行评价。结果:所有患者获得随访,时间12~28个月,术后切口愈合良好。A组患者术中出血量、手术时间均明显多于B组(P<0.05),骨折愈合时间明显少于B组(P<0.05)。两组患者术后2 d股骨颈长度比较差异无统计学意义(P>0.05),两组患者术后6个月股骨颈长度均较术后2 d缩短(P<0.05),且B组术后6个月股骨颈缩短较A组明显(P<0.05)。术后2 d、6个月TAD值组间比较差异均无统计学意义(P>0.05),两组术后2 d与术后6个月TAD值比较差异无统计学意义(P>0.05)。B组并发症发生率高于A组(P<0.05)。术后10个月A组髋关节Harris各项评分及总分均高于B组(P<0.05)。结论:加长PFNA联合MIPPO小钢板重建外侧壁固定,相比较单纯闭合复位PFNA固定治疗AO-A3.3型股骨转子间骨折,虽然手术时间及术中出血量增加,但术后促进骨折愈合,患者功能恢复更好,并发症显著减少。

Objective:To compare the clinical efficacy of lengthened proximal femoral nail anti-rotation(PFNA) combined with minimally invasive percutaneous plate osteosynthesis(MIPPO) and common PFNA in the treatment of AO-A3.3 intertrochanteric fracture.Methods:The clinical data of 58 patients with AO-A3.3 intertrochanteric fracture treated from January 2015 to April 2020 were retrospectively analyzed.Among them,27 patients were treated with extended PFNA+MIPPO plate to reconstruct the lateral wall(group A),and 31 patients were treated with closed reduction and PFNA fixation(group B).The bleeding volume,operation time,femoral neck length and tip apex distance(TAD),fracture healing time and postoperative complications were observed and compared between two groups.Harris score was used to evaluate hip joint function 10 months after operation.Results:All patients were followed up for 12 to 28 months.The incision healed well after operation.The bleeding volume and operation time of group A were significantly more than that of group B(P<0.05),and the fracture healing time of group A was significantly less than that of group B(P<0.05).There was no significant difference in the length of femoral neck between two groups at 2 days after operation(P>0.05).The length of femoral neck at 6 months after operation in each group was shorter than that at 2 days after operation(P<0.05),and the shortening of femoral neck at 6 months after operation in group B was significantly shorter than that in group A(P<0.05).There was no significant difference in TAD values between two groups at the same time point(P>0.05) at 2 days and 6 months after operation.There was no significant difference in TAD values between 2 days and 6 months after operation(P>0.05).The incidence of complications in group B was significantly higher than that in group A(P<0.05).The Harris scores of hip joint function in group A were higher than those in group B 10 months after operation(P<0.05).Conclusion:Compared with the treatment of AO-A3 femoral intertrochanteric fracture with closed reduction and PFNA fixation,the lengthened PFNA combined with MIPPO small plate for reconstruction and fixation of the lateral wall can promote the fracture healing,improve the patient’s functional recovery,and significantly reduce the complications.