PFNA治疗伴或不伴外侧壁损伤的股骨粗隆间骨折的效果分析

Analysis of the effect of PFNA in the treatment of femoral intertrochanteric fracture with or without lateral wall injury

目的:分析探讨股骨近端防旋髓内钉(PFNA)治疗股骨粗隆间骨折(IFF)的效果是否与股骨外侧壁(简称外侧壁)的完整性有关。方法:回顾性分析采用PFNA治疗IFF病人的临床资料。根据术前、术中、术后等影像学资料显示的外侧壁情况进行分组,分为外侧壁完整组(A组)和外侧壁损伤组(B组)(包括医源性外侧壁损伤),收集并比较2组病人的基线资料、术中和术后资料,探讨外侧壁完整性与PFNA手术效果之间的关系。结果:2组病人基线资料、尖顶距(TAD)值比较,差异均无统计学意义(P>0.05)。2组病人术中出血量、手术时间、切口长度、并发症发生率、术后6、12个月Harris髋关节功能评分优良率比较,差异有统计学意义(P<0.05~P<0.01)。结论:PFNA手术治疗IFF的效果与外侧壁的情况密切相关,外侧壁完整组较外侧壁损伤组病人手术效果好。术中应积极保护外侧壁避免发生医源性损伤。

Objective:To analyze and explore whether the effect of proximal femoral nail antirotation(PFNA)in the treatment of intertrochanteric fracture of femur(IFF)is related to the integrity of the lateral wall of the femur.Methods:The clinical data of IFF patients treated with PFNA were analyzed retrospectively.The patients were divided into two groups:intact lateral wall group(group A)and injured lateral wall group B(including iatrogenic lateral wall injury).The baseline,intraoperative and postoperative data of the two groups were collected,and the data differences between the two groups were compared to explore the relationship between lateral wall integrity and the effect of PFNA.Results:There was no significant difference in baseline data and TAD value between the two groups(P>0.05).There was a significant difference in intraoperative bleeding,operation time,incision length,incidence of complications,and excellent rate of Harris hip function score at 6 and 12 months after operation between the two groups(P<0.05 to P<0.01).Conclusions:The effect of PFNA surgery for IFF is closely related to the condition of the lateral wall,with better surgical results in the group with an intact lateral wall than in the group with a damaged lateral wall.The lateral wall should be actively protected to avoid medically-induced injury during surgery.