Proximal Femur Bionic Nail (PFBN): A Panacea for Unstable Intertrochanteric Femur Fracture

With the aging population,intertrochanteric femur fracture in the elderly has become one of the most serious public health issues and a hot topic of research in trauma orthopedics.Due to the limitations of internal fixation techniques and the insufficient mechanical design of nails,the occurrence of complications delays patient recovery after surgical treatment.Design of a proximal femur bionic nail(PFBN)based on Zhang’s N triangle theory provides triangular supporting fixation,which dramatically decreases the occurrence of complications and has been widely used for clinical treatment of unstable intertrochanteric femur fracture worldwide.In this work,we developed an equivalent biomechanical model to analyze improvement in bone remodeling of unstable intertrochanteric femur fracture through PFBN use.The results show that compared with proximal femoral nail antirotation(PFNA)and InterTan,PFBN can dramatically decrease the maximum strain in the proximal femur.Based on Frost’s mechanostat theory,the local mechanical environment in the proximal femur can be regulated into the medium overload region by using a PFBN,which may render the proximal femur in a state of physiological overload,favoring post-operative recovery of intertrochanteric femur fracture in the elderly.This work shows that PFBN may constitute a panacea for unstable intertrochanteric femur fracture and provides insights into improving methods of internal fixation.

Comparison of Clinical Effect of PFNA and Internal Fixation with Anatomical Locking Plate of Proximal Femur in Treatment of Intertrochanteric Fracture of Femur

Purpose:To investigate the clinical value of proximal femoral nail antirotation and anatomical locking plate of proximal femur in the treatment of intertrochanteric fracture of femur.Methods:The study group is treated with PFNA internal fixation.The control group is treated by internal fixation with anatomical locking plate of proximal femur.Results:The time of operation,the amount of intraoperative bleeding and the time of fracture healing in the study group are significantly less than those in the control group.The incidence rate of complication in the study group(3.23%)is significantly lower than that in the control group(17.2%).Data comparison shows P<0.05.Conclusion:The curative effect and prognosis for patients with intertrochanteric fracture of femur treated by PFNA internal fixation are more ideal.

Comparison of Clinical Effect of PFNA and Internal Fixation with Anatomical Locking Plate of Proximal Femur in Treatment of Intertrochanteric Fracture of Femur

Purpose To investigate the clinical value of proximal femoral nail antirotation and anatomical locking plate of proximal femur in the treatment of intertrochanteric fracture of femur.Methods The study group is treated with PFNA internal fixation.The control group is treated by internal fixation with anatomical locking plate of proximal femur.Results The time of operation,the amount of intraoperative bleeding and the time of fracture healing in the study group are significantly less than those in the control group.The incidence rate of complication in the study group(3.23%)is significantly lower than that in the control group(17.2%).Data comparison shows P<0.05.Conclusion The curative effect and prognosis for patients with intertrochanteric fracture of femur treated by PFNA internal fixation are more ideal.

Bone metabolism and trauma degree of magnetic-guided intramedullary nail fixation for femoral shaft fracture

Objective:To explore the effect of magnetic-guided intramedullary nail fixation on bone metabolism and trauma degree in patients with femoral shaft fracture.Methods: A total of 128 patients with femoral shaft fractures who received surgical treatment in the hospital between April 2016 and November 2017 were divided into control group (n=64) and study group (n=64) according to the random number table method. Control group received the traditional intramedullary nail treatment, and study group received magnetic-guided intramedullary nail treatment. The differences in serum levels of bone metabolism indexes and inflammatory factors were compared between the two groups 48 h after surgery.Results: 48 h after surgery, serum bone formation indexes BGP, PⅠNP, PⅠCP and BAP levels of study group were higher than those of control group whereas bone resorption indexesβ-CTX, TRACP5b and NTX levels were lower than those of control group;serum inflammatory factors TGF-β, hs-CRP, IL-1β, IL-6 and IL-17 levels were lower than those of control group.Conclusion:Compared with traditional intramedullary nail therapy, magnetic-guided intramedullary nail fixation can more effectively balance the bone metabolism status and reduce the fracture end trauma in patients with femoral shaft fracture.

Trauma and bone metabolism of magnetic navigation intramedullary nail and traditional intramedullary nail fixation treatment of femoral shaft fracture

Objective:To analyze the trauma and bone metabolism of magnetic navigation intramedullary nail and traditional intramedullary nail fixation treatment of femoral shaft fracture. Methods:58 patients with femoral shaft fracture treated in our hospital between December 2011 and December 2015 were divided into observation group and control group by random number table (n=29). Control group received conventional intramedullary nail fixation treatment, and observation group received magnetic navigation intramedullary nail fixation treatment. 24 h after surgery, blood coagulation indexes, enzymology indexes, bone metabolism indexes and angiogenesis indexes were determined;6 months after surgery, bone mineral density levels were determined. Results:24 h after surgery, peripheral blood thrombin time (TT), prothrombin time (PT), and activated partial thromboplastin time (APTT) levels of observation group were significantly higher than those of control group, and serum fibrinogen (FIB), D-Dimer (D-D), lactate dehydrogenase (LDH), creatine kinase (CK), creatine kinase isoenzyme (CKMB), glutamic oxalacetic transaminase (GOT), sex hormone-binding globulin type I (SHBG), collagen cross-linked carboxyl-terminal telopeptide (CTX) and deoxypyridinoline (DPD) content were lower than those of control group while bone gla protein (BGP), insulin-like growth factor (IGF-1), hypoxia-inducible factor-1α (HIF-α), angiogenin 1 (Ang-1), recombinant basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) content were higher than those of control group;6 months after surgery, fracture end bone mineral density (BMD) value of observation group was higher than that of control group. Conclusions:Magnetic navigation intramedullary nail treatment of femoral shaft fracture can more effectively reduce the surgical trauma, improve bone metabolism and increase bone mineral density.

Proximal Femoral Nail in Reverse Trochanteric Femoral Fractures: An Analysis of 53 Cases at One Year Follow-Up

Treatment of reverse oblique trochanteric femoral fractures poses a lot of challenges. There have been proponents of intramedullary devices as well as extramedullary devices. We present the results of proximal femoral nailing surgery performed for reverse obliquity intertrochanteric fractures using two proximal lag screws and a nail of 250 mm. There is prospective study of fifty three patients with AO/OTA 31 A-A3 fractures being treated by proximal femoral nailing in our institute after seeking approval from the Hospital ethics board. The quality of the reduction, the operative time, complications and the functional status of the patients were the parameters on which the results were evaluated. The mean Harris hip score was 76.66 (range 70 - 93) and the mean Barthel activity score was 16.21 (range 12 - 20). The average surgical time was 50 minutes and the mean consolidation time was 11.5 weeks. Intramedullary nailing with proximal femoral nails seems to be a good option in the treatment of reverse obliquity intertrochanteric fractures as against the various existing options available for the management.

Conversion hip arthroplasty for failed nailing of intertrochanteric fracture: Reflections on some important aspects

In this editorial,I present my comments on the article by Solarino et al.Conversion hip arthroplasty,which is an optional salvage procedure performed following unsuccessful fixation of intertrochanteric femur fractures in elderly pati-ents,entails more complex processes and higher rates of operative complications than primary arthroplasty.Hence,it is important to consider the appropriateness of the primary treatment choice,as well as the adequacy of nailing fixation for intertrochanteric fractures.This article briefly analyzes the possible factors contributing to the nailing failure of intertrochanteric fractures and attempts to find corresponding countermeasures to prevent fixation failures.It also analyzes the choice of treatment between nailing fixation and primary arthroplasty for intertrochanteric fractures.

Risk Assessment of Retrograde Intramedullary Nailing for Proximal Humeral Fracture

In proximal humeral fracture except AO classification 11A1, fixations with a locking plate and nails are recommended. We performed mechanical tests to investigate whether retrograde intramedullary nailing has fixation stability comparable to those of anterograde intramedullary nailing and locking plate which achieve clinically favorable outcomes. In retrograde intramedullary nailing, a nail entry point is made in the diaphysis, for which reduction of stiffness of the humerus is of concern. Thus, we investigated the influence of a nail entry point made in the diaphysis on humeral strength. Retrograde intramedullary nailing had fixation stability against bending and a force loaded in the rotation direction comparable to those of anterograde intramedullary nail and locking plate. Displacement by the main external force loaded on the humerus, compressive load, was less than half in the bone fixed by retrograde intramedullary nailing compared with that in the bone fixed with a locking plate, showing favorable fixation stability. It was clarified that stiffness of the humerus against rotation and a load in the compression direction is not reduced by a nail entry point made by retrograde intramedullary nailing.

Finite Element Analysis of Coronal Shear Fractures of the Femoral Neck: Displacement of the Femoral Head and Effect of Osteosynthetic Implants

Coronal shear fractures of the femoral neck (CSFF) are the most challenging to treat among proximal femur fractures, directly affecting the life expectancy of patients with osteoporosis. However, an adequate osteosynthesis method has not been elucidated yet. This study investigated the displacement direction of the femoral head fragment and its effect on the bone using finite element method. A finite element model for CSFF was developed from CT image data of a patient with osteoporosis using Mechanical Finder (ver. 11). Subsequently, finite element analyses were performed on six osteosynthesis models under maximum load applied during walking. The compressive stresses, tensile stresses, and compressive strains of each model were examined. The results suggested that the compressive and tensile stress distributions were concentrated on the anterior side of the femoral neck. Compressive strain distribution in the femoral head and neck was concentrated in four areas: at the tip of the blade or lag screw, the anteroinferior side of the blade or lag screw near the fracture site, and the upper right and lower left near the junction of the blade or lag screw and nail. Thus, the distribution of both these stresses revealed that the femoral head fragment was prone to anterior and inferior displacement. Distribution of compressive strains revealed the direction of the stress exerted by the osteosynthetic implant on the bone. The same results were observed in all osteosynthetic implants;thus, the findings could lay the foundation for developing methods for placing osteosynthetic implants less prone to displacement and the osteosynthetic implants themselves. In particular, the study provides insight into the optimal treatment of CSFF.

A comparative analysis of distal locked and unlocked long proximal femoral nail antirotation (PFNA-II) in the fixation of stable intertrochanteric fractures

Purpose:Long proximal femoral nail anti-rotation (PFNA-II) is a preferred implant in recent years for fixation of pertrochanteric fractures,especially in osteoporotic patients.The purpose of this study is to prospectively investigate the effect of distal locking in long PFNA-II fixation of stable intertrochanteric fractures.Methods:A total of 58 patients with isolated stable intertrochanteric fractures and treated in our hospital during the study period of 2017–2019 by distal locked or unlocked long PFNA-II fixation were included in this study.Patients who had multiple injuries or open fractures were excluded.There were 40 female and 18 male patients,with 33 affecting the left side and 25 the right side.Of them,31 belonged to the distal locked group (group A) and 27 to the unlocked group (group B).Surgical procedures and implants used in both groups were similar except for the distal locking of the nails.General data (age,gender,fracture side,etc.) showed no significant difference between two groups (allp > 0.05).The intraoperative parameters like operative time,radiation exposure and follow-up parameters like functional and radiological outcomes were recorded and compared.Statistical tests like the independent samplest-test Fischer’’s exact and Chi-square test were used to analyze association.Results:The distribution of the fractures according to AO/OTA classification and 31A1.2 type of intertrochanteric fractures were most common in our study.All the included fractures united and the average functional outcome in both groups were good and comparable at the end of one year.The operative time (mL,107.1 ± 12.6vs.77.0 ± 12.0,p < 0.001) and radiation exposure (s,78.6 ± 11.0vs.40.3 ± 9.3,p < 0.001) were significantly less among the patients in group B.Fracture consolidation,three months after the operative procedures,was seen in a significantly greater proportion of patients in group B (92.6%vs.67.7%,p = 0.025).Hardware irritation because of distal locking bolt was exclusively seen in group A,however this was not statistically significant (p = 0.241).Conclusion:We conclude that,in fixation of stable intertrochanteric fractures by long PFNA-II nail,distal locking not only increases the operative time and radiation exposure but also delays the fracture consolidation and increases the chances of hardware irritation,and hence is not required.

Intramedullary bone pedestal formation contributing to femoral shaft fracture nonunion:A case report and review of the literature

BACKGROUND Femoral shaft fracture is a commonly encountered orthopedic injury that can be treated operatively with a low overall delayed/nonunion rate.In the case of delayed union after antegrade or retrograde intramedullary nail fixation,fracture dynamization is often attempted first.Nonunion after dynamization has been shown to occur due to infection and other aseptic etiologies.We present a unique case of diaphyseal femoral shaft fracture nonunion after dynamization due to intramedullary cortical bone pedestal formation at the distal tip of the nail.CASE SUMMARY A 37-year-old male experienced a high-energy trauma to his left thigh after coming down hard during a motocross jump.Evaluation was consistent with an isolated,closed,left mid-shaft femur fracture.He was initially managed with reamed antegrade intramedullary nail fixation but had continued thigh pain.Radiographs at four months demonstrated no evidence of fracture union and failure of the distal locking screw,and dynamization by distal locking screw removal was performed.The patient continued to have pain eight months after the initial procedure and 4 mo after dynamization with serial radiographs continuing to demonstrate no evidence of fracture healing.The decision was made to proceed with exchange nailing for aseptic fracture nonunion.During the exchange procedure,an obstruction was encountered at the distal tip of the failed nail and was confirmed on magnified fluoroscopy to be a pedestal of cortical bone in the canal.The obstruction required further distal reaming.A longer and larger diameter exchange nail was placed without difficulty and without a distal locking screw to allow for dynamization at the fracture site.Post-operative radiographs showed proper fracture and hardware alignment.There was subsequently radiographic evidence of callus formation at one year with subsequent fracture consolidation and resolution of thigh pain at eighteen months.CONCLUSION The risk of fracture nonunion caused by intramedullary bone pedestal formation can be mitigated with the use of maximum length and diameter nails and close follow up.

髋关节囊周围神经阻滞与髂筋膜间隙阻滞对老年股骨粗隆间骨折患者镇痛效果的对比研究

目的 探讨髋关节囊周围神经(pericapsular nerve group, PENG)阻滞与髂筋膜间隙阻滞(fascia iliaca compartment block, FICB)对老年股骨粗隆间骨折(intertrochanteric femur fracture, IFF)患者股骨近端防旋髓内钉(proximal femoral nail anti-rotation, PFNA)内固定术的镇痛效果。方法 选取2022年1—12月首都医科大学附属北京积水潭医院老年IFF患者60例,随机分为P组和F组,每组各30例。P组采用PENG阻滞,F组采用FICB。两组患者均接受椎管内麻醉进行手术,术后均给予患者静脉自控镇痛(patient controlled intravenous analgesia, PCIA)。比较两组患者不同时点(T1,神经阻滞前;T2,神经阻滞后30 min;T3,术后6 h;T4,术后24 h;T5,术后48 h)静息和运动时的视觉模拟评分(visual analogue score, VAS)、术后补救镇痛率、镇痛满意度评分、住院时间、PCIA按压次数及不良反应发生率。结果 60例患者中,男23例,女37例,年龄65~85岁,平均(70.6±6.0)岁。两组T2~T5时点静息和运动时VAS均低于T1时点,差异均有统计学意义(P <0.05);两组静息和运动时所有时点VAS、术后补救镇痛率、镇痛满意度评分、住院时间、PCIA按压次数及不良反应发生率的比较,差异均无统计学意义(P>0.05)。结论 PENG阻滞与FICB均可缓解老年IFF患者PFNA内固定术的镇痛,且镇痛效果相当。

股骨近端防旋髓内钉-Ⅱ治疗31-A3型股骨转子间骨折扩髓与否的有限元分析

背景:针对股骨转子间骨折是否需要扩髓的问题尚有争议,一些人认为不扩髓缩短手术时间、减少出血、降低高龄患者术中风险,但此举是否会降低髓内钉支撑效果,尚无依据。另一些人认为扩髓可选择直径更粗的髓内钉,获得更好的力学支撑,但基础研究显示此方法存在脂肪栓塞、破坏骨质(尤其高龄骨质疏松患者)等风险。目的:通过有限元分析股骨近端防旋髓内钉-Ⅱ治疗31-A3型股骨转子间骨折时扩髓与不扩髓的力学分布特点。方法:纳入一名健康志愿者,CT扫描其股骨获取DICOM格式文件,顺序导入Mimics、Geomagic Wrap、SolidWorks、Hypermesh、Ansys软件处理文件,得到A3.1型、A3.2型及A3.3型股骨转子间骨折模型,分别与9,11 mm直径、170 mm长度的股骨近端防旋髓内钉-Ⅱ进行装配,赋予材料属性,设定各接触面相互作用关系及定义载荷及边界条件,之后进行求解。观察不同模型中股骨应力分布、内固定应力分布、股骨位移及内固定位移情况。结果与结论:①各型骨折采用扩髓髓内钉固定时股骨应力均小于非扩髓髓内钉固定,A3.3型骨折股骨最大应力值大于A3.1型和A3.2型;②各型骨折采用扩髓髓内钉固定时内固定应力均大于非扩髓髓内钉固定,A3.3型骨折内固定最大应力值大于A3.1型;③扩髓与非扩髓对股骨及内固定位移影响较小,应力影响较大;④提示采用扩髓髓内钉固定可使股骨应力减小,内固定整体承担应力增大,远端锁钉承担应力减小;与非扩髓髓内钉固定相比,采用扩髓髓内钉固定可能会提供更好的治疗效果。

老年股骨近端骨折围手术期处理流程的研究

目的研究老年股骨近端骨折围手术期处理流程,比较新旧流程体系的合理性以及治疗结果的有效性,不断改进,制定规范、合理的临床围手术期处置流程。方法本研究选取2016年1月—2019年7月包头医学院第三附属医院骨科使用旧有流程的老年髋部骨折患者102例,纳入旧流程组;2019年8月—2022年7月包头医学院第三附属医院骨科使用新流程患者118例,纳入新流程组。同时整理并收集新旧流程实施过程中的患者年龄、性别比例、入院诊断、平均手术等待时间、术中出血量、围手术期输血量,术后髋关节功能评定结果、手术并发症发生例数、平均医疗费用、平均住院时间、并发症加重情况等,通过收集数据进行组间比较,明确新旧流程实施结果。结果新流程组围手术期平均输血量为(257.63±77.24)mL,24 h内完成手术27例,平均住院医疗费用为(41602.6±11878.49)元,优于旧流程组的(333.33±135.22)mL、5例(、51790.49±15744.51)元,差异有统计学意义(P<0.05)。结论新流程的实施可以有效缩短手术等待时间,缩短该类患者的平均住院日,有效降低围手术期用血量,降低住院期间医疗支出,提高24 h内手术完成率,是行之有效的围手术期处置流程。

两种内固定术式治疗高龄无移位型股骨颈骨折的疗效

目的比较股骨近端锁定接骨板与空心螺钉内固定治疗高龄无移位型股骨颈骨折的疗效。方法根据内固定不同将66例高龄无移位型股骨颈骨折患者分为接骨板组(32例,采用股骨近端锁定接骨板内固定治疗)和螺钉组(34例,采用空心螺钉内固定治疗)。记录两组手术情况、骨折愈合时间、髋关节Harris评分、术后并发症发生情况。结果患者均获得随访,时间6~95个月。手术时间、切口长度、术中出血量、术后血红蛋白下降量两组比较差异均无统计学意义(P>0.05),下床部分负重锻炼时间接骨板组早于螺钉组(P<0.05)。接骨板组骨折均顺利愈合,时间3.5~8.0(4.63±1.04)个月;螺钉组中出现1例骨折不愈合,其余33例骨折愈合时间为3.0~7.5(5.03±1.04)个月;骨折愈合时间两组比较差异无统计学意义(P>0.05)。术后6个月髋关节Harris评分两组比较差异无统计学意义(P>0.05);但髋关节Harris评分优良率接骨板组高于螺钉组(P<0.05)。术后早期并发症发生率两组比较差异无统计学意义(P>0.05),中远期并发症发生率螺钉组高于接骨板组(P<0.05)。结论股骨近端锁定接骨板与空心螺钉内固定治疗高龄无移位型股骨颈骨折均可获得满意疗效,与空心螺钉相比,股骨近端锁定接骨板治疗早期髋关节功能恢复更好,中远期并发症更少。

髌上入路和髌下入路髓内钉内固定治疗胫骨骨折的效果

目的:探讨髌上入路和髌下入路髓内钉内固定治疗胫骨骨折的效果。方法:选取2019年1月—2023年10月靖江市人民医院收治的60例胫骨骨折患者为研究对象。根据随机抽签将其分为对照组和观察组,各30例。对照组给予髌下入路髓内钉内固定,观察组给予髌上入路髓内钉内固定。比较两组围手术期指标,术前及术后膝关节功能,并发症。结果:观察组手术时间及术后消肿时间、住院时间、骨折愈合时间均短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05)。术后3个月,观察组功能、活动度、肌力、屈曲畸形评分均高于对照组,差异有统计学意义(P<0.05)。观察组术后并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论:治疗胫骨骨折可采取髓内钉固定术方式,选择髌上入路相较髌下入路效果更佳,可促进患者术后膝关节功能的恢复,且减少并发症。

顺行交锁钉结合LISS内固定治疗Lambiris Ⅲ或Ⅳ型股骨骨折的临床效果

目的 探究顺行交锁钉结合微创内固定系统(LISS)内固定治疗LambirisⅢ或Ⅳ型股骨骨折的应用效果。方法 前瞻性选取2022年1月至2023年1月南阳市中心医院收治的95例股骨骨折(LambirisⅢ或Ⅳ型)患者,以简单随机法分为对照组(47例)和研究组(48例)。对照组接受常规LISS内固定治疗,研究组接受顺行交锁钉结合LISS内固定治疗。比较两组围手术期情况、创伤应激因子[超氧化物歧化酶(SOD)、去甲肾上腺素(NE)、血管紧张素Ⅱ(AngⅡ)]、视觉疼痛模拟量表(VAS)、硫化氢(H_(2)S)、鸢尾素(Irisin)、髋关节功能、并发症发生率。结果 研究组出血量为(357.49±32.81)mL,少于对照组的(385.94±37.26)mL,住院时间、骨折愈合时间分别为(17.63±2.29)d、(28.76±2.15)周,短于对照组的(19.51±2.64)d、(30.28±2.40)周(P<0.05)。研究组SOD、NE、AngⅡ水平术后第3天分别为(90.53±11.24)U·L^(-1)、(83.15±8.74)μg·L^(-1)、(148.62±18.53)mmol·L^(-1),低于对照组的(98.31±11.56)U·L^(-1)、(90.26±9.57)μg·L^(-1)、(163.78±19.37)mmol·L^(-1)(P<0.05)。研究组第3个月VAS评分为(1.97±0.65)分,低于对照组的(2.76±0.81)分(P<0.05);术后第3个月研究组H_(2)S、Irisin水平分别为(34.15±3.28)ng·L^(-1)、(217.83±16.45)μg·L^(-1),高于对照组的(32.28±3.11)ng·L^(-1)、(205.46±14.82)μg·L^(-1)(P<0.05);术后末次随访研究组髋关节功能优良率高于对照组(P<0.05)。结论 顺行交锁钉结合LISS内固定治疗LambirisⅢ或Ⅳ型股骨骨折患者,可减少出血,减轻应激反应,加快术后早期恢复,促进骨折愈合,恢复髋关节功能,减轻患者疼痛。

不同方法治疗老年股骨转子间不稳定骨折疗效对比

目的对比分析生物型加长柄关节置换与股骨近端防旋髓内钉内固定治疗老年股骨转子间不稳定骨折的临床效果。方法选取2019年6月至2021年6月安阳市第三人民医院收治的104例老年股骨转子间不稳定骨折患者作为研究对象,根据不同手术治疗方式将其分为置换组(52例)和固定组(52例),置换组患者采用生物型加长柄关节置换术治疗,固定组患者采用股骨近端防旋髓内钉内固定术治疗,对比观察两组患者围术期相关指标、髋关节恢复情况、生活质量及术后不良事件发生情况。结果置换组患者术中出血量明显多于固定组、手术时间明显长于固定组(t=5545、5150,P均<0001),而首次下床活动时间及住院时间与固定组无明显差异(t=1933、1619,P=0056、0109)。术后12个月,置换组患者髋关节恢复优良率为8077%,明显高于固定组患者的髋关节恢复优良率6154%(χ^(2)=4685,P=0030);置换组患者健康调查量表36(SF-36)中的躯体功能、躯体疼痛、总体健康、生理功能评分均明显高于固定组(t=3062、2868、3028、3440,P=0003、0005、0003、0001)。置换组患者术后不良事件发生率为577%,明显低于固定组患者的术后不良事件发生率2115%(χ^(2)=5283,P=0022)。结论与股骨近端防旋髓内钉内固定相比,生物型加长柄关节置换虽会增加老年股骨转子间不稳定骨折患者术中出血量,延长手术时间,但能够提高患者髋关节功能及生活质量,降低不良事件发生风险,临床效果更佳。

PFNA和ALP治疗股骨转子间骨折患者的疗效及对血清SO、DKK-3水平的影响

目的 探究股骨近端防旋型髓内钉(PFNA)和股骨近端解剖型锁定钢板(ALP)治疗股骨转子间骨折患者的疗效及对血清骨硬化蛋白(SO)、Dickkopf-3(DKK-3)水平的影响.方法 选取我院2021年4月1日~2023年3月31日符合条件的78例股骨转子间骨折患者,按照抽签法分为对照组(n=39)和研究组(n=39).对照组患者采用ALP髓外固定治疗,研究组患者采用PFNA髓内固定治疗.评估两组患者的手术相关临床指标、并发症情况以及治疗前后的Harris评分、血清DKK-3与SO水平.结果 研究组患者的手术时间、住院时间、下地负重时间、切口长度明显短于对照组,术中出血量明显少于对照组,差异有统计学意义(P<0.05);治疗后,研究组髋内翻、内固定物松动、感染、静脉血栓、压疮、关节脱位等并发症的总发生率明显低于对照组,差异有统计学意义(P<0.05);治疗前两组疼痛、功能、活动度评分比较,差异无统计学意义(P>0.05),治疗后研究组疼痛、功能、活动度评分均明显高于对照组,差异有统计学意义(P<0.05);治疗前两组血清DKK-3、SO水平比较,差异无统计学意义(P>0.05),治疗后研究组血清DKK-3、SO水平明显低于对照组,差异有统计学意义(P<0.05).结论 相较于ALP髓外固定治疗,PFNA髓内固定治疗在股骨转子间骨折患者中的应用效果更好,可加速患者术后恢复速度,提高患者髋关节功能,降低并发症发生率,并改善患者血清DKK-3、SO水平.

人工股骨头置换术与PFNA固定对老年股骨转子间骨折患者髋关节功能恢复的影响

目的:探讨人工股骨头置换术与近端防旋髓内钉(Proximal Femoral Nail Antirotation,PFNA)固定在老年股骨转子间骨折(Intertrochanteric fracture,IFF)中的应用效果。方法:选取2018年1月至2022年12月我院收治的36例老年IFF患者作为研究对象,按随机数字表法分为对照组和观察组,各18例。对照组进行PFNA固定术治疗,观察组进行人工股骨头置换术治疗。分析比较两组的手术情况、髋关节功能、日常生活能力和平衡功能及并发症。结果:观察组手术时间较对照组长,术中出血量较对照组多,下床活动时间、术后住院时间较对照组短,有统计学差异(P<0.05)。观察组术后Harris评分中关节功能、畸形、疼痛程度、关节活动度及总分均明显高于对照组(P<0.05)。观察组术后Barthel量表(Barthel index,BI)评分、Berg平衡量表(Berg balance scale,BBS)评分均明显高于对照组(P<0.05)。两组并发症相比无明显差异(P>0.05)。结论:人工股骨头置换术治疗老年IFF效果更佳,可缩短术后下床活动时间,加快患者髋关节功能恢复,提高BI评分及BBS评分,安全可靠。