股骨近端仿生髓内钉与股骨近端防旋髓内钉固定治疗老年股骨转子间骨折的效果比较

Comparison of proximal femoral bionic nail and proximal femoral nail anti-rotation in fixation of intertrochanteric fractures of the femur in the aged patients

目的:比较股骨近端仿生髓内钉(PFBN)与股骨近端防旋髓内钉(PFNA)固定治疗老年骨质疏松性股骨转子间骨折的效果。方法:回顾性分析2020年12月至2022年6月期间北京大学人民医院创伤骨科收治的83例老年股骨转子间骨折患者资料。根据内固定方式不同分为两组:PFBN组40例,男15例,女25例;年龄(81.4±9.1)岁;骨折分型:31-A2型27例,31-A3型13例;采用PFBN固定治疗。PFNA组43例,男16例,女27例;年龄(80.2±11.6)岁;骨折分型:31-A2型30例,31-A3型13例;采用PFNA固定治疗。比较两组患者的手术时间、术中出血量、住院时间、并发症发生率,以及术后18个月疼痛视觉模拟评分(VAS)、日常生活评分(ADL)、髋关节Harris评分等。结果:两组患者术前一般资料及随访时间比较差异均无统计学意义( P>0.05),具有可比性。两组患者的手术时间、术中出血量、住院时间及术后18个月疼痛VAS评分比较差异均无统计学意义( P>0.05)。PFBN组患者术后18个月ADL评分[(69.0±15.0)分]及髋关节Harris评分[(78.1±6.9)分]均显著高于PFNA组患者[(61.8±14.9)、(75.0±10.2)分],差异均有统计学意义( P<0.05)。PFBN组患者术后并发症发生率为5.0%(2/40),低于PFNA组患者(14.0%,6/43),但差异无统计学意义( P>0.05)。 结论:PFBN与PFNA固定治疗老年骨质疏松性股骨转子间骨折均可取得良好疗效。与PFNA相比,PFBN固定术后患者髋关节功能恢复更好,生活质量更优。

ObjectiveTo compare the effectiveness between proximal femoral bionic nail(PFBN)and proximal femoral nail antirotation(PFNA)in the fixation of osteoporotic intertrochanteric fractures of the femur in the aged patients.MethodsA retrospective analysis was conducted of the data of 83 aged patients with intertrochanteric fracture of the femur who had been admitted to Department of Orthopaedics and Traumatology,Peking University People's Hospital from December 2020 to June 2022.The patients were divided into 2 groups based on their methods of internal fixation.In the PFBN group of 40 cases,there were 15 males and 25 females aged(81.4±9.1)years,and 27 cases of type 31-A2 and 13 cases of type 31-A3;in the PFNA group of 43 cases,there were 16 males and 27 females aged(80.2±11.6)years,and 30 cases of type 31-A2 and 13 cases of type 31-A3.The 2 groups were compared in terms of surgical time,intraoperative blood loss,length of hospital stay,incidence of complications,and visual analogue scale(VAS),activity of daily living(ADL),and Harris hip score at 18 months after surgery.ResultsThe differences in preoperative general data between the 2 groups were not statistically significant,indicating comparability(P>0.05).There was no statistically significant difference between the 2 groups in surgical time,intraoperative blood loss,hospital stay,or VAS pain score at 18 months after surgery(P>0.05).The Harris hip score[(78.1±6.9)points]and ADL score[(69.0±15.0)points]at 18 months after surgery in the PFBN group were significantly higher than those in the PFNA group[(75.0±10.2)points and(61.8±14.9)points](P<0.05).The incidence of postoperative complications in the PFBN group was 5.0%(2/40),insignificantly lower than that in the PFNA group(14.0%,6/43)(P>0.05).ConclusionsBoth PFBN and PFNA can achieve good therapeutic effects in the fixation of osteoporotic intertrochanteric fractures of the femur in the age patients.Compared with PFNA fixation,patients undergoing PFBN fixation may have better functional recovery of the hip joint and higher life quality.