骨水泥强化型与传统型股骨近端防旋髓内钉内固定治疗老年骨质疏松性股骨转子间不稳定性骨折的对比研究

A comparative study of bone cement-reinforced versus conventional proximal femoral nail antirotation internal fixation for treatment of unstable osteoporotic intertrochanteric fractures in the aged

目的:比较骨水泥强化型与传统型股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定治疗老年骨质疏松性股骨转子间不稳定性骨折的临床疗效和安全性。方法:回顾性分析60例老年骨质疏松性股骨转子间不稳定性骨折患者的临床资料,其中采用骨水泥强化型PFNA内固定治疗28例(骨水泥强化组)、采用传统型PFNA内固定治疗32例(传统组)。比较2组患者的手术时间、术中失血量、尖顶距(tip-apex distance,TAD)、术后辅助下负重时间、骨折愈合时间、并发症发生率,以及术后3个月、6个月、12个月的Harris髋关节评分。结果:①一般指标。骨水泥强化组患者手术时间长于传统组[(63.79±3.72)min,(58.06±4.52)min,t=5.309,P=0.000],术后辅助下负重时间、骨折愈合时间均短于传统组[(4.39±1.66)d,(5.81±1.96)d,t=-3.003,P=0.004;(5.75±1.51)个月,(6.65±1.62)个月,t=-2.235,P=0.029];2组患者术中失血量、TAD的组间差异均无统计学意义[(69.29±10.78)mL,(67.19±10.77)mL,t=0.753,P=0.455;(22.29±1.80)mm,(22.47±1.85)mm,t=-0.387,P=0.700]。②Harris髋关节评分。术后3个月、6个月,骨水泥强化组Harris髋关节评分均高于传统组[(70.07±5.33)分,(66.97±5.51)分,t=2.210,P=0.031;(83.00±2.57)分,(77.16±4.24)分,t=6.550,P=0.000];术后12个月,两组Harris髋关节评分的差异无统计学意义[(90.25±3.42)分,(88.91±3.57)分,t=1.480,P=0.143]。③并发症发生率。骨水泥强化组出现1例谵妄,传统组出现2例骶尾部压伤、2例坠积性肺炎、1例尿路感染、1例谵妄、2例螺旋刀片切出、1例退钉;传统组并发症发生率高于骨水泥强化组(χ^(2)=4.835,P=0.028)。结论:采用骨水泥强化型PFNA内固定治疗老年骨质疏松性股骨转子间不稳定性骨折,与传统型PFNA内固定比较,患者术后辅助下负重早、骨折愈合快、髋关节功能恢复快,且安全性更高,但手术时间较长。

Objective:To compare the clinical outomes and safety of bone cement-einforced versus conventional proximal femoral nail antirotation(PFNA)internal fisation in treatment of unstable osteoporotic intertrochanteric fractures in the aged.Methods:The dlinical data of 60 patients with unstable osteoporotic intertrochanteric fractures were retrospectively analyzed.Twenty-eight patients were treated with bone cement-reinforced PFNA internal fixation(bone cement-reinforced group),and 32 ones with conventional PFNA internal fixation(conventional group).The operative time,intraoperative blood loss,tip-apex distance(TAD),postoperative partial weight-bearing walk start time,fracture healing time,complication incidence rate,and the Harris hip score evaluated at postoperative month 3,6 and 12 were compared between the 2 groups.Results:①The operative time was longer,the postoperative partial weight-bearing walk start time and fracture healing time were shorter in bone cement-reinforced group compared to conventional group(63.79±3.72 vs 58.06±4.52 minutes,t=5.309,P=0.000;4.39±1.66 vs5.81±1.96 days,t=-3.003,P=0.004;5.75±1.51 vs6.65±1.62 months,t=-2.235,P=0.029);while the comparison of intraoperative blood loss and TAD between the 2 groups revealed no significant differences(69.29±10.78 vs 67.19±10.77 ml,t=0.753,P=0.455;22.29±1.80 vs22.47±1.85 mm,t=-0.387,P=0.700).②The Harris hip score was higher in bone cement-reinforced group compared to conventional group at postoperative month 3 and 6(70.07±5.33 vs 66.97±5.51.points,t=2.210,P=0.031;83.00±2.57 vs 77.16±4.24 points,t=6.550,P=0.000);while,at postoperative month 12,the dfference between the 2 goups was not stitically signifcant(90.25±3.42 vs 88.91±3.57 points,t=1.480,P=0.143).③Ater the procedure,the delirium(1 case)was found in bone cement-reinforced group;while the sacrococy geal compression injury(2 cases),hypostatic pneumonia(2 cases),urinary tract infection(1 case),delirum(1 case),spiral blade protrusion from femoral head(2 cases)and nail dropped out(1 case)were found in conventional group.The incidence rate of postoperative complications was lower in bone cement-reinforced group compared to conventional group(χ^(2)=4.835,P=0.028).Conclusion;The bone cement-reinforced PFNA internal fixation displays the advantages of earlier postoperative partial weight-bearing walk,faster fracture healing and hip function recovery with higher safety,but the disadvantage of longer operative time compared to the conventional PFNA internal fixat ion in tre atmnent of unstable osteoporotic intertrochanteric fractures in the aged.