钢板辅助外侧壁重建结合加长InterTan髓内钉固定治疗外侧壁破裂型股骨粗隆间骨折的疗效

Plate-assisted posterolateral wall reconstruction combined with lengthened InterTan intramedullary nail fixation in the treatment of posterolateral wall-ruptured intertrochanteric femur fractures

目的观察钢板辅助外侧壁重建结合加长InterTan髓内钉固定治疗外侧壁破裂型股骨粗隆间骨折的疗效。方法前瞻性选取2019年1月至2020年12月收治的沧州中西医结合医院45例外侧壁破裂型股骨粗隆间骨折患者作为观察组,选取同期性别、AO/OTA分型、骨折侧别与其相匹配的45例外侧壁破裂型股骨粗隆间骨折患者作为对照组。对照组采用加长InterTan髓内钉固定治疗,观察组采用钢板辅助外侧壁重建结合加长InterTan髓内钉固定治疗。比较两组手术情况、术后并发症发生情况及尖顶距、术后1周、6个月、1年的Harris评分、整体复位效果。结果观察组手术时间为(97.63±15.33)min,较对照组[(78.96±14.41)min]长,术后下地时间和术后开始负重时间、愈合时间分别为(6.25±1.17)d、(6.52±1.27)周、(12.17±2.22)周,均较对照组[(7.89±1.45)d、(8.44±1.45)周、(14.96±2.87)周]短,术中出血量为(187.74±30.29)mL,较对照组[(142.23±25.56)mL]多,差异均有统计学意义(P<0.05);但两组放射暴露时间比较,差异无统计学意义(P>0.05)。两组近期和远期并发症发生情况比较,差异无统计学意义(P>0.05)。两组术后1周、6个月、1年的尖顶距比较,差异均无统计学意义(P>0.05)。两组术后1周、6个月、1年的Harris评分均较术前升高,且观察组术后1周、6个月、1年的Harris评分分别为(83.11±6.07)、(88.97±4.27)、(89.45±4.82)分,均高于对照组[(80.14±5.69)、(86.52±4.96)、(86.86±5.23)分],差异均有统计学意义(P<0.05)。两组术后1年整体复位效果比较,差异无统计学意义(P>0.05)。结论钢板辅助外侧壁重建结合加长InterTan髓内钉固定治疗外侧壁破裂型股骨粗隆间骨折可促进患者术后早期下地和开始负重,缩短骨折愈合时间,改善髋关节功能。

Objective To observe the efficacy of plate-assisted posterolateral wall reconstruction combined with lengthened InterTan intramedullary nail fixation in the treatment of intertrochanteric fractures of the femur with posterolateral wall rupture.Methods A total of 45 patients with lateral wall ruptured femoral intertrochanteric fractures admitted to Cangzhou Integrated Traditional Chinese and Western Medicine Hospital from January 2019 to December 2020 were prospectively selected as the observation group,and 45 patients with lateral wall ruptured femoral intertrochanteric fractures matched by gender,AO/OTA classification and fracture side were selected as the control group.These individuals underwent surgical intervention using a novel approach that integrates plate-assisted posterolateral wall reconstruction and an elongated InterTan intramedullary nail for stabilization,forming the study group.The control group was treated with extended InterTan intramedullary nail fixation,while the observation group was treated with plate-assisted lateral wall reconstruction combined with extended InterTan intramedullary nail fixation.The operation conditions,postoperative complications,tip-apex distance,Harris score at 1 week,6 months and 1 year after operation and overall reduction effect were compared between the two groups.Results The operation time of the observation group was(97.63±15.33)min,which was longer than that of the control group[(78.96±14.41)min],the postoperative ambulation time,postoperative weight-bearing time and healing time were(6.25±1.17)d,(6.52±1.27)weeks and(12.17±2.22)weeks,respectively,which were shorter than those of the control group[(7.89±1.45)d,(8.44±1.45)weeks and(14.96±2.87)weeks],the intraoperative blood loss was(187.74±30.29)mL,which was longer than that of the control group[(142.23±25.56)mL],the difference was statistically significant(P<0.05).However,there was no statistically significant difference in radiation exposure time between the two groups(P>0.05).There was no statistically significant difference in the incidence of short-term and long-term complications between the two groups(P>0.05).There was no statistically significant difference in the apical distance between the two groups at 1 week,6 months and 1 year after operation(P>0.05).The Harris scores of the two groups at 1 week,6 months and 1 year after operation were higher than those before operation,and the Harris scores of the observation group at 1 week,6 months and 1 year after operation were(83.11±6.07),(88.97±4.27),(89.45±4.82)points,which were higher than those of the control group[(80.14±5.69),(86.52±4.96),(86.86±5.23)points],the differences were statistically significant(P<0.05).There was no statistically significant difference in the overall reduction effect between the two groups at 1 year after operation(P>0.05).Conclusion Plate-assisted posterolateral wall reconstruction combined with lengthened InterTan intramedullary nail fixation for the treatment of posterolateral wall ruptured intertrochanteric femur fracture promotes patients to get down to the ground at an early postoperative stage,shortens the fracture healing,and improves the function of the hip joint,but attention should be paid to the timing of the operation during the operation.