PFNA联合重建钢板治疗股骨粗隆间不稳定骨折伴外侧壁损伤的临床疗效分析

Clinical Analysis of PFNA Combined with Reconstructive Plates in the Treatment of Unstable Intertrochanteric Fracture of Femur with Lateral Wall Injury

目的研究股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)联合重建钢板治疗伴外侧壁损伤的股骨粗隆间不稳定骨折的临床疗效,并提出伴外侧壁损伤的股骨粗隆间不稳定骨折的复位内固定的五点稳定性理论。方法回顾性分析我院从2018年1月至2020年8月治疗的56例伴外侧壁损伤的股骨粗隆间不稳定骨折患者,其中26例采用PFNA结合重建钢板治疗(研究组),30例采用PFNA治疗(对照组)。比较手术时间、术中出血量、骨折愈合情况、并发症发生率,术后6个月和12个月的Harris髋关节评分(Harris hip score,HHS)和Parker-Palmer活动度评分(Parker-Palmer mobility score,PPMS)。结果研究组手术时间比对照组长,为(96.2±27.4)min vs.(64.7±31.8)min,术中出血量更多,为(236.8±53.6)mL vs.(147.3±58.3)mL(P<0.01),但骨折愈合时间更短,为(11.7±3.2)周vs.(15.4±4.3)周(P=0.034),固定失败率在数值上更低,但无统计学差异(P=0.189)。术后6个月和12个月,研究组的HHS和PPMS均高于对照组(P<0.05)。结论PFNA结合重建钢板手术时间长,术中出血多,但在骨折愈合时间、固定失败率在数值上更低,但无统计学差异。并发症发生率和术后功能恢复方面优于单用PFNA。对于伴外侧壁损伤的股骨粗隆间骨折,本研究在Abram的三点稳定性理论的基础上提出了五点稳定性理论,即头颈钉头部、大转子入口处的主钉、侧壁入口处的头钉尾部稳定性,及外侧壁钢板的远近端稳定性,对此类骨折复位与内固定更具有指导意义。

Objective To explore the clinical efficacy of proximal femoral nail antirotation(PFNA)combined with reconstructive plates in the treatment of unstable intertrochanteric fractures with lateral wall injury.Methods A retrospective analysis was carried out,including 26 patients treated with PFNA combined with reconstruction plates(the study group),and 30 patients treated with femoral intramedullary nail only(the control group).The basic clinical information and parameters of the two groups were collected.During the follow-up of 6 and 12 months after operation,the Harris hip score(HHS)and Parker-Palmer mobility score(PPMS)was evaluated to assess the functional status of the two groups.Results Compared with the control group,the study group had longer operation time,(64.7±31.8)min vs.(96.2±27.4)min,more intraoperative hemorrhage,(147.3±58.3)mL vs.(236.8±53.6)mL(P<0.01),shorter fracture healing time(15.4±4.3)weeks vs.(11.7±3.2)weeks(P=0.034)and lower fixation failure rate in value.HSS and PPM of the study group was higher than that in the control group(P<0.05).Conclusion For femoral intertrochanteric fractures involving the lateral wall,PFNA combined with reconstruction plates can be used to assist reduction and fixation,which can effectively improve the quality of fracture reduction,accurately complete intramedullary nail fixation,and ultimately facilitate fracture healing and rapid recovery of patients,although with longer operation time and more intra-operative hemorrhage.For the intertrochanteric fracture of femur with lateral wall injury,this study proposes a five point stability theory based on Abram's three-point stability theory the stability of the head and neck nail head,the main nail at the entrance of the greater trochanter,the tail of the head nail at the entrance of the lateral wall,and the stability of the distal and proximal of the lateral wall steel plate,which is more instructive for the reduction and internal fixation of such fractures.