股骨近端锁定加压钢板与股骨近端防旋型髓内钉治疗老年股骨粗隆间外侧壁粉碎性骨折的效果

Effect of PFLCP and PFNA in the treatment of elderly comminuted fractures of femoral intertrochanteric lateral wall

目的探究股骨近端锁定加压钢板(PFLCP)与股骨近端防旋型髓内钉(PFNA)治疗老年股骨粗隆间外侧壁粉碎性骨折的有效性及对髋关节功能恢复与术后愈合的影响。方法回顾性选取2019年9月至2021年12月龙口市人民医院骨科收治的行PFLCP或PFNA手术的老年股骨粗隆间外侧壁粉碎性骨折患者85例,依据手术方式不同,将患者分为PFLCP组(41例)和PFNA组(44例),PFLCP组患者行PFLCP手术,PFNA组患者行PFNA手术。观察并比较2组患者手术时间、术中出血量、术后引流量、骨性愈合时间、下地时间和住院时间等手术相关指标、临床疗效、术前及术后3个月疼痛视觉模拟评分量表(VAS)评分、行走能力评分和生活质量情况,统计2组患者出现髋内翻、内固定松动、内固定断裂、下肢静脉血栓和感染等并发症发生率。结果PFNA组患者手术时间、骨性愈合时间和下地时间短于PFLCP组,术中出血量少于PFLCP组(P<0.05)。PFLCP组总优良率为68.29%,PFNA组总优良率为88.64%,PFNA组Harris等级优于PFLCP组(P<0.05),总优良率高于PFLCP组(P<0.05)。PFNA组术后并发症总发生率为4.54%,低于PFLCP组的19.52%(P<0.05)。术前2组患者VAS评分、行走能力评分、心理功能、生理功能、日常活动和社会功能等生活质量得分评分均差异无统计学意义(P>0.05),术后3个月,PFNA组VAS评分低于PFLCP组,行走能力评分高于PFLCP组(P<0.05),PFNA组各项生活质量评分均高于PFLCP组(P<0.05)。结论PFNA治疗老年股骨粗隆间外侧壁粉碎性骨折效果优于PFLCP,可有效改善髋关节功能,加速骨折愈合。

Objective To explore the effectiveness of proximal femoral locking compression plate(PFLCP)and proximal femoral nail anti-rotation(PFNA)in the treatment of elderly comminuted fractures of femoral intertrochanteric lateral wall as well as their effects on hip function recovery and postoperative healing.Methods Eighty-five elderly patients with comminuted fractures of of femoral intertrochanteric lateral wall who underwent PFLCP or PFNA in the hospital were retrospectively selected between September 2019 and December 2021.According to different surgical methods,the patients were divided into PFLCP group(n=41)and PFNA group(n=44).The patients in the PFLCP group underwent PFLCP surgery,while the patients in the PFNA group performed PFNA surgery.The surgery-related indicators such as surgical time,intraoperative blood loss,postoperative drainage volume,osseous healing time,ambulation time and hospital stay,clinical efficacy as well as pain Visual Analogue Scale(VAS)score,walking ability score and quality of life before surgery and at 3 months after surgery were observed and compared between the two groups.The incidence rates of complications such as coxa varus,internal fixation loosening,internal fixation rupture,lower extremity venous thrombosis and infection were statistically analyzed in the two groups.Results The surgical time,osseous healing time,and ambulation time in PFNA group were shorter than those in PFLCP group,and the intraoperative blood loss was less than that in PFLCP group(P<0.05).The overall excellent and good rate was 68.29% in PFLCP group and 88.64% in PFNA group,and the Harris grading in PFNA group was better than that in PFLCP group(P<0.05),and the overall excellent and good rate was higher than that in PFLCP group(P<0.05).The overall incidence rate of 4.54% in PFNA group was lower than 19.52% in PFLCP group(P<0.05).There were no statistical differences in the VAS score,walking ability score and scores of quality of life aspects such as psychological function,physiological function,daily activities and social function between the two groups before surgery(P>0.05).At 3 months after surgery,the VAS score in PFNA group was lower than that in PFLCP group while the walking ability score was higher than that in PFLCP group(P<0.05),and the scores of items of quality of life were higher in PFNA group than those in PFLCP group(P<0.05).Conclusions PFNA is more effective than PFLCP in the treatment of elderly comminuted fractures of femoral intertrochanteric lateral wall,and the former one can effectively improve hip function and accelerate postoperative fracture healing.