InterTan结合重建钢板治疗老年股骨转子间骨折PFNA内固定术后髓钉断裂的疗效分析

Feasibility and efficacy of InterTan intramedullary nail internal fixation combined with reconstruction plate in the treatment of nail breakage after PFNA in femoral intertrochanteric fracture

目的分析采用InterTan髓内钉结合外侧重建钢板的方法治疗老年股骨转子间骨折PFNA内固定术后髓钉断裂的疗效。方法回顾性分析2016年2月至2022年5月山西省晋城市人民医院收治的因股骨转子间骨折行股骨近端防旋髓内钉PFNA内固定术后出现髓钉断裂的患者10例,断裂的位置均是螺旋刀片与主钉结合处,采用InterTan髓内钉结合股骨近端外侧重建钢板的方法进行翻修手术。通过临床资料分析髓钉断裂的原因,记录翻修手术的相关指标及并发症,记录翻修手术前及末次随访的Harris评分、SF-12评分。结果10例患者初次均为不稳定的转子间骨折,髓钉断裂发生于PFNA术后5~13个月,平均(9.7±2.9)个月。所有患者均顺利完成翻修手术,平均住院(28.8±3.3)d。出院后平均随访(13.4±2.3)个月。至随访末期,所有骨折均愈合,平均愈合时间(11.2±1.7)个月。末次Harris评分[(80.67±2.50)分]与术前Harris评分[(23.33±3.56)分]相比较,差异有统计学意义(P<0.05)。末次SF-12评分[身体总得分(44.00±10.18)分,精神总得分(49.50±1.87)分]相比较术前[身体总得分(24.83±1.72)分,精神总得分(26.33±2.42)分],差异有统计学意义(P<0.05)。结论骨折类型的不稳定、骨折复位质量差、骨折不愈合是髓钉断裂的三大主要因素;采用InterTan髓内钉结合外侧重建钢板的方法对老年股骨转子间骨折PFNA内固定术后出现髓钉断裂的患者进行翻修,翻修术后短期内随访结果满意,为临床上遇到类似病例提供了一种可供参考治疗方案。

Objective To explore the feasibility and efficacy of InterTan intramedullary nail internal fixation combined with reconstruction plate in the treatment of nail breakage after PFNA in femoral intertrochanteric fracture.Methods A retrospective analysis was performed to analyze 10 patients with nail breakage after PFNA internal fixation due to intertrochanteric fracture from February 2016 to May 2022 in Jincheng People's Hospital.InterTan intramedullary nail combined with proximal lateral femoral reconstruction plate were used for revision surgery.The causes of nail breakage were analyzed through clinical data,and the relevant indicators and complications of revision surgery were recorded.Harris scores and SF-12 score were recorded.Results All 10 patients had unstable intertrochanteric fractures at the time of first surgery.The mean time of nail breakage after PFNA was(9.7±2.9)months.All patients successfully underwent revision surgery,with an average hospital stay of(28.8±3.3)d.The average follow-up time after revision was(13.4±2.3)months.At the end of follow-up,all fractures healed with an average healing time of(11.2±1.7)months.There was a statistically significant difference between the last Harris score and the preoperative Harris score(P<0.05).There was a statistically significant difference between the last SF-12 score[total physical score(44.00±10.18),total mental score(49.50±1.87)]and the preoperative SF-12 score[total physical score(24.83±1.72),total mental score(26.33±2.42)](P<0.05).Conclusion Unstable fracture type,poor reduction quality and non-union of fracture are the three main factors of medullary nail breakage.The method of using the InterTan intramedullary nail combined with lateral reconstruction steel plate was used for revision in elderly patients with femoral intertrochanteric fractures who experienced nail breakage after PFNA internal fixation surgery.The short-term follow-up results after revision were satisfactory,providing a reference treatment plan for similar cases in clinical practice.