加长PFNA与普通PFNA治疗不稳定股骨粗隆间骨折的效果比较

Comparison of therapeutic effects of extended PFNA and ordinary PFNA on unstable intertrochanteric fractures

目的分析加长股骨近端防旋髓内钉(PFNA)与普通PFNA治疗不稳定股骨粗隆间骨折(IFF)的效果。方法队列研究。抽取2020年1月至2024年4月南阳市中医院收治的68例不稳定IFF患者, 按随机数字表法分为对照组和观察组, 每组34例。对照组行普通PFNA内固定术治疗, 观察组行加长PFNA内固定术治疗。比较两组围术期指标、功能康复情况、应激反应、髋关节功能及并发症发生情况。结果两组住院与骨折愈合时间比较差异未见统计学意义(P>0.05);观察组术中出血量[(143.57±17.31)mL]多于对照组[(120.31±15.89)mL], 手术时间[(72.48±6.31)min]长于对照组[(57.33±4.45)min], 下床负重时间[(3.26±0.36)d]短于对照组[(4.01±0.87)d], P<0.05。观察组并发症发生率(5.88%, 2/34)低于对照组(23.53%, 8/34), P<0.05。术后, 观察组去甲肾上腺素、皮质醇、血管紧张素Ⅱ水平及髋关节Harris评分量表评分均高于对照组(P均<0.05)。结论相较于普通PFNA, 加长PFNA会增加创伤, 延长手术时间, 但其更能够恢复不稳定IFF患者髋关节功能, 且并发症更少。

Objective To analyze the effects of extended proximal femoral nail anti-rotation(PFNA)and ordinary PFNA in the treatment of unstable intertrochanteric fractures(IFF).Methods A total of 68 patients with unstable IFF admitted to Nanyang Traditional Chinese Medicine Hospital from January 2020 to April 2024 were selected for the cohort study.And they were divided into the control group and the observation group according to random number table method,with 34 cases in each group.The control group was treated by general PFNA internal fixation treatment,and the observation group received extended PFNA internal fixation treatment.Perioperative indexes,functional rehabilitation status,stress response,hip function,and incidence of complications were compared between the two groups.Results There was no significant difference in hospital stay and fracture healing time between the two groups(P>0.05).The intraoperative blood loss in the observation group was(143.57±17.31)mL,which was higher than the(120.31±15.89)mL in the control group(P<0.05).The operation duration in the observation group was(72.48±6.31)min,which was longer than the(57.33±4.45)min in the control group(P<0.05).The out-of-bed loading time in the observation group was(3.26±0.36)d,which was shorter than the(4.01±0.87)d in the control group(P<0.05).The incidence of complications of the observation group(5.88%,2/34)was lower than that of the control group(23.53%,8/34),P<0.05.The observation group had lower levels of norepinephrine,cortisol and angiotensinⅡ,moreover,it had higher hip joint Harris scale score compared with the control group(P<0.05).Conclusions Compared with ordinary PFNA,extended PFNA can increase trauma and prolong operation duration,but it can better restore hip function in patients with unstable IFF,with fewer complications.