股骨近端抗旋髓内钉固定转子间骨折是否重建外侧壁

Proximal femoral nail anti-rotation with or without lateral wall reconstruction for femoral intertrochanteric fractures

[目的]比较股骨近端抗旋髓内钉(proximal femoral nail anti-rotation,PFNA)治疗股骨转子间骨折是否重建外侧壁的临床效果。[方法]回顾性分析2017年1月—2021年6月手术治疗外侧壁骨折型股骨转子间骨折60例患者的临床资料。依据术前医患沟通结果,31例采用重建锁定钢板外侧壁重建+PFNA固定(重建组),另外29例单纯PFNA固定(未重建组)。比较两组围手术期、随访及影像资料。[结果]所有患者手术顺利,术中无神经、血管损伤。两组手术时间、术中出血量、切口总长度、术中透视次数、一次置钉成功率、螺旋刀片长度、切口愈合等级、住院时间的差异均无统计学意义(P>0.05)。但是,重建组下地时间显著早于未重建组[(14.1±1.8) d vs (18.5±2.9) d,P<0.05]。患者平均随访(19.0±4.3)个月。重建组完全负重时间显著早于未重建组[(13.6±3.4)周vs (18.5±2.9)周,P<0.05]。随术后时间推移,两组Harris评分、髋伸屈ROM、内收外展ROM均显著增加(P<0.05);相应时间点,重建组上述指标均显著优于未重建组(P<0.05)。影像学方面,两组骨折复位质量的差异无统计学意义(P<0.05)。末次随访时,重建组的NSA [(127.3±2.7)°vs (124.8±1.7)°,P<0.05]和股骨头颈短缩[(4.1±0.7) mm vs (5.1±0.6) mm,P<0.05]均显著优于未重建组。[结论] PFNA固定股骨转子间骨折重建外侧壁可增强固定的稳定性,有利于髋关节功能恢复,减少并发症发生。

[Objective]To compare the clinical efficacy of proximal femoral nail anti-rotation(PFNA)with or without lateral wall reconstruction for femoral intertrochanteric fractures.[Methods]A retrospective study was conducted on 60 patients who received PFNA for femoral intertrochanteric fractures complicated with lateral wall fractures in our department from January 2017 to June 2021.According to the preoperative doctor-patient communication,31 patients underwent PFNA and lateral wall reconstruction with a locking plate(the reconstruction group),while the other 29 patients received PFNA alone(the non-reconstruction group).The perioperative period,follow-up and imaging data of the two groups were compared.[Results]All the patients were operated on smoothly without nerve and vascular injury.Although there were no significant differences in operation time,intraoperative blood loss,total incision length,intraoperative fluoroscopy times,success rate of the first nail placement,screw blade length,incision healing grade and hospital stay between the two groups(P>0.05),the reconstruction group resumed ambulation significantly earlier than the non-reconstructed group[(14.1±1.8)days vs(18.5±2.9)days,P<0.05].All patients in both groups were followed up for an average of(19.0±4.3)months,and the reconstruction group returned to full weightbearing activity significantly earlier than the non-reconstructed group[(13.6±3.4)weeks vs(18.5±2.9)weeks,P<0.05].The Harris score,hip extension-flexion range of motion(ROM)and adduction-abduction ROM significantly increased in both groups with postoperative time(P<0.05),which in the reconstruction group proved significantly better than those in the non-reconstructed group at all time points accordingly(P<0.05).Radiologically,there was no significant difference in reduction quality between the two groups(P>0.05).At the last followup,the reconstruction group was also significantly superior to the non-reconstruction group in terms of neck-shaft angle(NSA)[(127.3±2.7)°vs(124.8±1.7)°,P<0.05]and extent of femoral head-neck shortening[(4.1±0.7)mm vs(5.1±0.6)mm,P<0.05].[Conclusion]The lateral wall reconstruction in PFNA fixation of femoral intertrochanteric fractures does enhance the stability of fixation,facilitate the functional recovery of hip joint and reduce complications in this study.