Objective To investigate the operative method and evaluate the clinical outcomes of long proximal femoral nail anti-rotation (PFNA-long) in treating long-segment fracture in middle-up part of femoral bone.Methods From...Objective To investigate the operative method and evaluate the clinical outcomes of long proximal femoral nail anti-rotation (PFNA-long) in treating long-segment fracture in middle-up part of femoral bone.Methods From June 2006 to展开更多
目的:探究老年股骨粗隆间骨折患者应用股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)与髋关节置换术的治疗效果。方法:回顾性分析2020年1月—2022年9月于景德镇市第二人民医院骨科确诊的老年粗隆间骨折患者60例的临床...目的:探究老年股骨粗隆间骨折患者应用股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)与髋关节置换术的治疗效果。方法:回顾性分析2020年1月—2022年9月于景德镇市第二人民医院骨科确诊的老年粗隆间骨折患者60例的临床资料。依据手术方法不同分为PFNA组(30例)及关节置换组(30例)。PFNA组行PFNA术治疗,关节置换组采用髋关节置换术治疗。对比两组围手术期指标、髋关节优良率、并发症发生率。结果:相比于关节置换组,PFNA组手术时间及住院时间均较短,术中出血量较少,差异均有统计学意义(P<0.05)。相比于关节置换组,PFNA组术后14 d、术后3个月髋关节优良率均较高,差异均有统计学意义(P<0.05);术后6个月,两组髋关节功能优良率及并发症发生率对比,差异均无统计学意义(P>0.05)。结论:两种术式在股骨粗隆间骨折患者治疗中均可获得理想效果,能够有效恢复患者髋关节功能。在手术方式选择中则需依据患者病情进行判断,以选择最佳的手术方式,获得理想的手术效果。展开更多
Purpose: The proximal femoral nail anti-rotation (PFNA) is known to have advantages in enhancing the anchorage ability of internal fixation in elderly unstable osteoporotic intertrochanteric fracture patients. However...Purpose: The proximal femoral nail anti-rotation (PFNA) is known to have advantages in enhancing the anchorage ability of internal fixation in elderly unstable osteoporotic intertrochanteric fracture patients. However whether it is superior to condylar blade fixation is not clear. This study aimed to determine which treatment has better clinical outcomes in older patients. Materials and Methods: A total of 86 patients over the age of 60 with unstable trochanteric fractures within the past 3 weeks, were included in this prospective study conducted from June 1, 2018, to May 31, 2021. All the intertrochanteric fractures were classified according to AO/OTA classification. Among them, 44 cases were treated with the Proximal Femoral Nail (PFNA2) with or without an augmentation screw, and 42 cases were treated with the Condylar Blade Plate. In addition, the operative time, intraoperative blood loss, intraoperative and postoperative blood transfusion, postoperative weight-bearing time, hospitalization time, Harris score of hip function, Kyle’s criteria and postoperative complications were compared between the two groups. Results: The mean duration of surgery for the PFN group was 66.8 minutes (on average), whereas for the condylar blade plate group, it was 99.30 minutes (on average). The PFNA2 group experienced less blood loss (average of 80 mL) compared to the condylar blade plate group (average of 120 mL). Union and partial weight-bearing occurred earlier in the PFNA2 group (14.1 weeks and 10.6 weeks, respectively) compared to the Condylar blade plate group (18.7 weeks and 15.8 weeks). In two patients from the PFNA2 group, screw backing out and varus collapse complications were encountered;however, these patients remained asymptomatic and did not require revision surgery. In two other patients, screw cut out and breakage of the nail at the helical screw hole leading to non-union of the proximal femur were observed during the nine-month follow-up, necessitating revision surgery with prosthetic replacement. Among the condylar blade plate group, three patients experienced complications, including blade breakage at the blade and plate junction. In two cases, the fracture united in varus, and in one case, the blade cut through, resulting in non-union of the femoral head, which required revision surgery. According to the Harris hip score and Kyle’s criteria, a good-excellent outcome was observed in 92.85% of cases in the PFNA2 group and 90.90% of cases in the condylar blade plate group. Conclusion: Both the Proximal Femoral Nail A2 and Condylar blade plate are effective implants for the treatment of unstable trochanteric fractures. The intramedullary implant promotes biological healing and allows for early ambulation with minimal complications. Similarly satisfactory restoration of anatomy and favorable radiological and functional results can be achieved with the biological fixation provided by the 95-degree condylar blade plate. However, the use of PFNA2 internal fixation technique has the advantage of less trauma in elderly patients than the 95-degree condylar blade plate.展开更多
目的对比亚洲型股骨近端髓内钉(asian type proximal femoral nail,APFN)与抗旋股骨近端髓内钉(proximal femoral nail antirotation,PFNA)治疗老年股骨转子间骨折的疗效。方法回顾性分析2018年4月—2021年9月连云港市中医院诊治的老年...目的对比亚洲型股骨近端髓内钉(asian type proximal femoral nail,APFN)与抗旋股骨近端髓内钉(proximal femoral nail antirotation,PFNA)治疗老年股骨转子间骨折的疗效。方法回顾性分析2018年4月—2021年9月连云港市中医院诊治的老年股骨转子间骨折患者96例的临床资料,以不同手术方案分组,对照组56例采用PFNA治疗,治疗组40例采用APFN治疗。对比两组手术相关指标,关节功能评分,疼痛情况及术后并发症指标。结果治疗组术中失血量、透视次数、住院时间均优于对照组,差异有统计学意义(P<0.05)。治疗组术后3、6个月髋关节功能评分量表(Harris Hip Score,HHS)评分高于对照组,差异有统计学意义(P<0.05)。治疗组并发症发生率(7.50%)明显低于对照组(23.21%),差异有统计学意义(χ^(2)=4.149,P<0.05)。结论与PFNA内固定比较,采用APFN治疗老年股骨转子间骨折可有效减少术中失血和透视次数,缩短住院时间,促进髋关节功能恢复,减轻患者术后疼痛,且安全性高。展开更多
目的:探讨高龄重度骨质疏松股骨粗隆间骨折患者的最佳治疗方案。方法:对我院收治的高龄重度骨质疏松股骨粗隆间骨折采用股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)内固定治疗后螺旋刀片切出的1例临床资料进行回顾...目的:探讨高龄重度骨质疏松股骨粗隆间骨折患者的最佳治疗方案。方法:对我院收治的高龄重度骨质疏松股骨粗隆间骨折采用股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)内固定治疗后螺旋刀片切出的1例临床资料进行回顾性分析。结果:该病例为81岁女性,因摔倒致右髋部疼痛伴活动受限8 h入院。髋部X线检查示右股骨粗隆间骨折,遂行PFNA内固定术,术后5 d复查髋部X线示螺旋刀片切出,患者髋关节活动受限。应患者及家属要求,行螺旋刀片翻修术,术后复查髋部X线示右股骨粗隆间骨折对位对线良好,内固定装置位置好。结论:PFNA内固定适于骨质疏松不稳定型股骨粗隆间骨折患者,但对于重度骨质疏松且骨把持力较差的患者,需改进手术方法或考虑行髋关节置换术。展开更多
文摘Objective To investigate the operative method and evaluate the clinical outcomes of long proximal femoral nail anti-rotation (PFNA-long) in treating long-segment fracture in middle-up part of femoral bone.Methods From June 2006 to
文摘目的:探究老年股骨粗隆间骨折患者应用股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)与髋关节置换术的治疗效果。方法:回顾性分析2020年1月—2022年9月于景德镇市第二人民医院骨科确诊的老年粗隆间骨折患者60例的临床资料。依据手术方法不同分为PFNA组(30例)及关节置换组(30例)。PFNA组行PFNA术治疗,关节置换组采用髋关节置换术治疗。对比两组围手术期指标、髋关节优良率、并发症发生率。结果:相比于关节置换组,PFNA组手术时间及住院时间均较短,术中出血量较少,差异均有统计学意义(P<0.05)。相比于关节置换组,PFNA组术后14 d、术后3个月髋关节优良率均较高,差异均有统计学意义(P<0.05);术后6个月,两组髋关节功能优良率及并发症发生率对比,差异均无统计学意义(P>0.05)。结论:两种术式在股骨粗隆间骨折患者治疗中均可获得理想效果,能够有效恢复患者髋关节功能。在手术方式选择中则需依据患者病情进行判断,以选择最佳的手术方式,获得理想的手术效果。
文摘Purpose: The proximal femoral nail anti-rotation (PFNA) is known to have advantages in enhancing the anchorage ability of internal fixation in elderly unstable osteoporotic intertrochanteric fracture patients. However whether it is superior to condylar blade fixation is not clear. This study aimed to determine which treatment has better clinical outcomes in older patients. Materials and Methods: A total of 86 patients over the age of 60 with unstable trochanteric fractures within the past 3 weeks, were included in this prospective study conducted from June 1, 2018, to May 31, 2021. All the intertrochanteric fractures were classified according to AO/OTA classification. Among them, 44 cases were treated with the Proximal Femoral Nail (PFNA2) with or without an augmentation screw, and 42 cases were treated with the Condylar Blade Plate. In addition, the operative time, intraoperative blood loss, intraoperative and postoperative blood transfusion, postoperative weight-bearing time, hospitalization time, Harris score of hip function, Kyle’s criteria and postoperative complications were compared between the two groups. Results: The mean duration of surgery for the PFN group was 66.8 minutes (on average), whereas for the condylar blade plate group, it was 99.30 minutes (on average). The PFNA2 group experienced less blood loss (average of 80 mL) compared to the condylar blade plate group (average of 120 mL). Union and partial weight-bearing occurred earlier in the PFNA2 group (14.1 weeks and 10.6 weeks, respectively) compared to the Condylar blade plate group (18.7 weeks and 15.8 weeks). In two patients from the PFNA2 group, screw backing out and varus collapse complications were encountered;however, these patients remained asymptomatic and did not require revision surgery. In two other patients, screw cut out and breakage of the nail at the helical screw hole leading to non-union of the proximal femur were observed during the nine-month follow-up, necessitating revision surgery with prosthetic replacement. Among the condylar blade plate group, three patients experienced complications, including blade breakage at the blade and plate junction. In two cases, the fracture united in varus, and in one case, the blade cut through, resulting in non-union of the femoral head, which required revision surgery. According to the Harris hip score and Kyle’s criteria, a good-excellent outcome was observed in 92.85% of cases in the PFNA2 group and 90.90% of cases in the condylar blade plate group. Conclusion: Both the Proximal Femoral Nail A2 and Condylar blade plate are effective implants for the treatment of unstable trochanteric fractures. The intramedullary implant promotes biological healing and allows for early ambulation with minimal complications. Similarly satisfactory restoration of anatomy and favorable radiological and functional results can be achieved with the biological fixation provided by the 95-degree condylar blade plate. However, the use of PFNA2 internal fixation technique has the advantage of less trauma in elderly patients than the 95-degree condylar blade plate.
文摘目的对比亚洲型股骨近端髓内钉(asian type proximal femoral nail,APFN)与抗旋股骨近端髓内钉(proximal femoral nail antirotation,PFNA)治疗老年股骨转子间骨折的疗效。方法回顾性分析2018年4月—2021年9月连云港市中医院诊治的老年股骨转子间骨折患者96例的临床资料,以不同手术方案分组,对照组56例采用PFNA治疗,治疗组40例采用APFN治疗。对比两组手术相关指标,关节功能评分,疼痛情况及术后并发症指标。结果治疗组术中失血量、透视次数、住院时间均优于对照组,差异有统计学意义(P<0.05)。治疗组术后3、6个月髋关节功能评分量表(Harris Hip Score,HHS)评分高于对照组,差异有统计学意义(P<0.05)。治疗组并发症发生率(7.50%)明显低于对照组(23.21%),差异有统计学意义(χ^(2)=4.149,P<0.05)。结论与PFNA内固定比较,采用APFN治疗老年股骨转子间骨折可有效减少术中失血和透视次数,缩短住院时间,促进髋关节功能恢复,减轻患者术后疼痛,且安全性高。
