[1]江孝龙,蒋国华,孙贤杰.股骨近端防旋髓内钉内固定与动力髋螺钉内固定治疗老年股骨转子间骨折的对比研究[J].中医正骨,2019,31(02):8-13.
　JIANG Xiaolong,JIANG Guohua,SUN Xianjie.A comparative study of internal fixation with proximal femoral nail antirotation versus dynamic hip screw for treatment of intertrochanteric fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(02):8-13.
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股骨近端防旋髓内钉内固定与动力髋螺钉内固定治疗老年股骨转子间骨折的对比研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期数:
2019年02期
页码:
8-13
栏目:
临床研究
出版日期:
2019-02-20

文章信息/Info

Title:
A comparative study of internal fixation with proximal femoral nail antirotation versus dynamic hip screw for treatment of intertrochanteric fractures in the aged
作者:
江孝龙; 蒋国华; 孙贤杰
(浙江省荣军医院,浙江 嘉兴 314000)
Author(s):
JIANG Xiaolong; JIANG Guohua; SUN Xianjie
Zhejiang Rongjun Hospital,Jiaxing 314000,Zhejiang,China
关键词:
髋骨折;  转子间骨折;  老年人;  骨折固定术; 内;  股骨近端防旋髓内钉;  动力髋螺钉;  疗效比较研究
Keywords:
hip fractures;  intertrochanteric fractures;  aged;  fracture fixation; internal;  proximal femoral nail antirotation;  dynamic hip screw;  comparative effectiveness research
摘要:
目的:比较股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定与动力髋螺钉(dynamic hip screw,DHS)内固定治疗老年股骨转子间骨折的临床疗效和安全性。方法:回顾性分析95例老年股骨转子间骨折患者的病例资料,其中采用PFNA内固定治疗52例(PFNA组),采用DHS内固定治疗43例(DHS组)。男38例,女57例。年龄60～91岁,中位数67岁。按照股骨转子间骨折的Evans分型,Ⅰ型39例、Ⅱ型56例。比较2组患者的术中出血量、手术时间、住院时间、骨折愈合时间、Harris髋关节功能评分及并发症发生情况。结果:①一般指标。PFNA组患者手术时间、住院时间均短于DHS组[(73.6±11.3)min,(83.6±13.2)min,t=4.058,P=0.000;(15.4±6.9)d,(17.6±7.8)d,t=3.655,P=0.000],术中出血量小于DHS组[(168.2±19.6)mL,(219.3±25.5)mL,t=11.039,P=0.000]; 2组患者骨折愈合时间比较,差异无统计学意义[(15.3±3.3)周,(16.7±5.8)周,t=1.371,P=0.174]。②Harris髋关节功能评分。时间因素和分组因素不存在交互效应(F=0.164,P=0.721); 2组患者Harris髋关节功能评分比较,组间差异无统计学意义,即不存在分组效应(F=0.317,P=0.752); 手术前后不同时间点Harris髋关节功能评分的差异有统计学意义,即存在时间效应(F=31.253,P=0.000); 2组患者Harris髋关节功能评分随时间均呈上升趋势,且2组的上升趋势完全一致[(38.2±8.2)分,(86.6±5.9)分,(88.4±5.0)分,(90.2±5.2)分,F=40.328,P=0.000;(40.7±9.3)分,(84.7±6.8)分,(86.5±5.2)分,(88.7±6.3)分,F=22.453,P=0.000]。③综合疗效。术后24个月,PFNA组临床治愈27例、显效21例、有效2例、无效2例,DHS组临床治愈17例、显效19例、有效5例、无效2例; 2组患者综合疗效比较,差异无统计学意义(Z=-1.407,P=0.159)。④安全性。PFNA组3例发生螺旋刀片部分或完全切出,1例出现髋内翻,1例出现骨折延迟愈合。DHS组5例出现螺钉退出,1例出现断钉,3例出现股骨颈短缩,3例出现髋内翻,2例出现下肢深静脉血栓,2例出现骨折延迟愈合。PFNA组患者并发症发生率低于DHS组(χ2=10.408,P=0.001)。结论:PFNA内固定与DHS内固定治疗老年股骨转子间骨折,均能促进髋关节功能恢复,二者的临床疗效和骨折愈合时间相当,但前者较后者手术时间短、术中出血量少、住院时间短、并发症少。
Abstract:
Objective:To compare the clinical curative effects and safety of internal fixation with proximal femoral nail antirotation(PFNA)versus dynamic hip screw(DHS)in treatment of intertrochanteric fractures in the aged.Methods:The medical records of 95 aged patients with intertrochanteric fractures were analyzed retrospectively.Fifty-two patients were treated with PFNA internal fixation(PFNA group),while the others were treated with DHS internal fixation(DHS group).The patients consisted of 38 males and 57 females,and ranged in age from 60 to 91 years(Median=67 yrs).According to the Evans classification of intertrochanteric fractures,the fractures belonged to typesⅠ(39)andⅡ(56).The intraoperative blood loss,operative time,hospital stay,fracture healing time,Harris hip function scores and complications were compared between the 2 groups.Results:The operative time and hospital stay were shorter and the intraoperative blood loss was less in PFNA group compared to DHS group(73.6+/-11.3 vs 83.6+/-13.2 min,t=4.058,P=0.000; 15.4+/-6.9 vs 17.6+/-7.8 days,t=3.655,P=0.000; 168.2+/-19.6 vs 219.3+/-25.5 mL,t=11.039,P=0.000).There was no statistical difference in the fracture healing time between the 2 groups(15.3+/-3.3 vs 16.7+/-5.8 weeks,t=1.371,P=0.174).There was no interaction between time factor and group factor in Harris hip function scores(F=0.164,P=0.721).There was no statistical difference in Harris hip function scores between the 2 groups,in other words,there was no group effect(F=0.317,P=0.752).There was statistical difference in Harris hip function scores between different timepoints before and after the surgery,in other words,there was time effect(F=31.253,P=0.000).The Harris hip function scores presented a time-dependent increasing trend in the 2 groups,and the 2 groups were consistent with each other in the increasing trend of Harris hip function scores(38.2+/-8.2,86.6+/-5.9,88.4+/-5.0,90.2+/-5.2 points,F=40.328,P=0.000; 40.7+/-9.3,84.7+/-6.8,86.5+/-5.2,88.7+/-6.3 points,F=22.453,P=0.000).At 24 months after the surgery,27 patients were cured,21 good,2 fair and 2 poor in PFNA group; while 17 patients were cured,19 good,5 fair and 2 poor in DHS group.There was no statistical difference in the total curative effects between the 2 groups(Z=-1.407,P=0.159). Partial or complete protrusion of spiral blade(3 cases),coxa vara(1 case)and delayed union of fracture(1 case)were found in PFNA group,while screw withdrawal(5 cases),screw breakage(1 case),femoral neck shortening(3 cases),coxa vara(3 cases),lower extremity deep venous thrombosis(2 cases)and delayed union of fracture(2 cases)were found in DHS group.The complication incidence was lower in PFNA group compared to DHS group(χ2=10.408,P=0.001).Conclusion:Both PFNA internal fixation and DHS internal fixation can promote hip function recovery in treatment of intertrochanteric fractures in the aged,and they are similar to each other in clinical curative effect and fracture healing time,however,the former has such advantages as shorter operative time and hospital stay,less intraoperative blood loss and complications compared to the latter.

参考文献/References:

[1] 贾连顺.现代脊柱外科学[M].北京:人民军医出版社,2007:812-813. [2] 柳登顺.实用颈腰肢痛诊疗手册[M].郑州:河南科学技术出版社,2002:547. [3] 刘云鹏,刘沂.骨与关节损伤和疾病的诊断分类及功能评定标准[M].北京:清华大学出版社,2002:71-72. [4] 中华中医药学会.中医骨伤科常见病诊疗指南[M].北京:中国中医药出版社,2012:154-157. [5] 孙俊俊,王亚峰,张壮,等.毫针针刺手法对腰椎间盘突出症效应影响的系统评价[J].针灸临床杂志,2017,33(7):51-57. [6] 李晓宇,孙晶,李荣荣,等.浅谈苍龟探穴针法在腰痛治疗中的应用[J].浙江中医药大学学报,2018,42(3):251-254. [7] 陈安亮,李伟,程凯,等.不同强度针刺对脑卒中后痉挛肌影响的研究[J].中医学报,2014,29(12):1848-1850. [8] 蒲红春.扬刺环跳穴治疗坐骨神经痛41例疗效观察[J].湖南中医杂志,2013,29(1):87-88. [9] GOLDMAN N,CHEN M,FUJITA T,et al.Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture[J].Nat Neurosci,2010,13(7):883-888. [10] 王蔚文.临床疾病诊断与疗效判断标准[M].北京:科学技术文献出版社,2011:592. [11] 周桂桐.试论时间与针灸治疗的关系[J].天津中医学院学报,2002,21(4):23-24. [12] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:123. [13] SUZUKAMO Y,FUKUHARA S,KIKUCHI S,et al.Validation of the Japanese version of the roland-morris disability questionnaire[J].J Orthop Sci,2003,8(4):543-548. [14] 叶长青,张海林,张宝良.中药活血止痛酊中频导入联合推拿治疗腰椎间盘突出症血瘀证的临床研究[J].中医正骨,2016,28(9):27-29. [15] 雷龙鸣,黄锦军,林桂权,等.三通推拿法治疗腰椎间盘突出症:多中心、随机对照研究[J].中国针灸,2011,31(3):253-257. [16] 陈大为,高乐女,邱玲.针刺神经干治疗坐骨神经痛研究进展[J].四川中医,2007,25(1):40-42. [17] 袁启令,刘亮,马江涛,等.针刺治疗慢性非特异性腰痛的临床研究[J].中医正骨,2016,28(6):12-17. [18] KONG J,GOLLUB R,HUANG T,et al.Acupuncture de qi,from qualitative history to quantitative measurement[J].J Altern Complement Med,2007,13(10):1059-1070. [19] CHOI Y,CHO S,LEE J,et al.The relationship between deqi and the effect of acupuncture[J].BMC Complement Alternat Med,2012,12(Suppl 1):172. [20] 李具宝,熊启良,屈尚可,等.近10年针灸治疗腰椎间盘突出症选穴规律的探讨[J].中国针灸,2013,33(7):668-672. [21] ZHI M J, LIU K, ZHENG Z L,et al.Application of the chronic constriction injury of the partial sciatic nerve model to assess acupuncture analgesia[J].J Pain Res,2017,10:2271-2280.

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备注/Memo

备注/Memo:
(收稿日期:2018-11-06 本文编辑:时红磊)
更新日期/Last Update: 2019-02-20