InterTan髓内钉与解剖型股骨近端髓内钉治疗老年股骨转子间骨折的疗效比较

Comparative Study of InterTan Intramedullary Nail and Zimmer Natural Nail System in the Treatment of Intertrochanteric Fractures in the Elderly

为探讨Inter Tan髓内钉与解剖型股骨近端髓内钉(ZNN)治疗老年股骨转子间骨折的临床疗效,通过回顾性研究方法研究从2013年1月～2018年1月的年龄大于65岁的股骨转子间骨折患者。最终收入114例。其中男性56例,女性58例。平均年龄为77. 88岁。采用Inter Tan髓内钉治疗69例,ZNN髓内钉治疗45例。比较两组患者手术时长,术中出血量,术后第3 d、第7 d,以及术后1月、3月视觉模拟评分。术后并发症以及术后3月、6月髋关节Harris评分。结果表明两组患者手术时长具有统计学差异(P <0. 01),Inter Tan髓内钉组手术时长较长。两组术中出血量没有统计学差异(P=0. 12)。两组患者术后第3 d、第7 d,以及术后1月、3月视觉模拟评分没有统计学差异(P=0. 77、P=0. 06、P=0. 32、P=0. 56)。术后3月、6月髋关节Harris评分,两组患者没有统计学差异(P=0. 39、P=0. 27)。两组均未有患者出现伤口感染,内固定失败,假体周围骨折等并发症。可见短期随访研究对于老年股骨转子间骨折,采用ZNN髓内钉与Inter Tan髓内钉均可以获得满意疗效。但是In-ter Tan髓内钉操作步骤复杂,手术时长较长,所以对于手术耐受能力较差的患者,推荐采用ZNN髓内钉进行固定。

In order to investigate the clinical efficacy of InterTan intramedullary nail and zimmer natural nail system( ZNN) in the treatment of intertrochanteric fractures in the elderly. Patients with femoral intertrochanteric fractures older than 65 years who were treated from January 2013 to January 2018 were enrolled. A total of 114 patients were eventually included. There were 56 males and 58 females. The average age was 77. 88 years. 69 patients underwent InterTan intramedullary nailing and 45 patients underwent ZNN intramedullary nail. The duration of operation,the amount of intraoperative blood loss,the visual analogue scale( VAS) of third day,seventh day after surgery,and the first and third months after surgery were compared between the two groups. Postoperative complications and hip Harris scores in the first and third months after surgery were also recorded. The results show that there is a statistically significant difference in the duration of surgery between the two groups( P < 0. 01). The InterTan intramedullary nail fixation group has a longer duration of surgery. There is no significant difference in intraoperative blood loss between the two groups( P = 0. 12). There are no significant differences in VAS scores between the two groups on the 3 rd day,7 th day,and 1 st and 3 rd month after surgery( P = 0. 77,P = 0. 06,P =0. 32,P = 0. 56). No statistically different between the two groups at hip Harris scores on the 3 rd and 6 th month after surgery( P = 0. 39,P = 0. 27). There are no complications such as wound infection,internal fixation failure,and periprosthetic fracture. It is concluded that the short-term follow-up study finds that ZNN and InterTan intramedullary nails can achieve satisfactory results in the treatment of intertrochanteric fractures in the elderly. However,InterTan intramedullary nails have complicated operation steps and long operation time. Therefore,ZNN intramedullary nails are recommended for patients with poor surgical tolerance.