[1]王守宝,杨峰,张振清,等.重建锁定接骨板联合股骨近端防旋髓内钉内固定治疗合并外侧壁破裂的A3型老年股骨转子间骨折的临床研究[J].中医正骨,2022,34(12):23-28.
　WANG Shoubao,YANG Feng,ZHANG Zhenqing,et al.A clinical study of reconstruction locking plate and PFNA internal fixation for treatment of type A3 femoral intertrochanteric fractures complicated with lateral wall rupture in elderly patients[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(12):23-28.
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重建锁定接骨板联合股骨近端防旋髓内钉内固定治疗合并外侧壁破裂的A3型老年股骨转子间骨折的临床研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期数:
2022年12期
页码:
23-28
栏目:
临床研究
出版日期:
2022-12-02

文章信息/Info

Title:
A clinical study of reconstruction locking plate and PFNA internal fixation for treatment of type A3 femoral intertrochanteric fractures complicated with lateral wall rupture in elderly patients
作者:
王守宝; 杨峰; 张振清; 郝成俊
(淮安市第五人民医院,江苏 淮安 223300)
Author(s):
WANG Shoubao; YANG Feng; ZHANG Zhenqing; HAO Chengjun
The Fifth People's Hospital of Huai'an,Huai'an 223300,Jiangsu,China
关键词:
髋骨折;  转子间骨折;  骨折固定术; 内;  股骨近端防旋髓内钉;  锁定钢板;  临床试验
Keywords:
hip fractures;  intertrochanteric fractures;  fracture fixation; internal;  proximal femoral nail antirotation;  locking plate;  clinical trial
摘要:
目的:观察重建锁定接骨板联合股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定治疗合并外侧壁破裂的A3型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40例合并外侧壁破裂的A3型老年股骨转子间骨折患者的病例资料,其中采用重建锁定接骨板联合PFNA内固定治疗20例(重建锁定接骨板联合PFNA组)、单纯采用PFNA内固定治疗20例(PFNA组)。比较2组患者手术时间、术中出血量、住院时间、术后下地时间、骨折愈合时间、股骨偏心距短缩、尖顶距、Harris髋关节评分及并发症发生率。结果:①一般结果。2组患者手术时间、术中出血量比较,组间差异均无统计学意义[(114.12±12.52)min,(105.24±10.61)min,t=1.724,P=0.062;(309.12±18.37)mL,(278.55±20.14)mL,t=1.956,P=0.059]; 重建锁定接骨板联合PFNA组患者住院时间、术后下地时间均短于PFNA组[(11.0±1.5)d,(17.3±2.3)d,t=2.510,P=0.041;(26.4±5.5)d,(41.0±6.2)d,t=2.131,P=0.012]。②疗效评价结果。重建锁定接骨板联合PFNA组患者骨折愈合时间短于PFNA组[(9.8±1.2)周,(13.6±3.1)周,t=2.371,P=0.036]; 股骨偏心距短缩小于PFNA组[(0.3±0.2)mm,(0.8±0.1)mm,t=1.658,P=0.020]; 2组患者尖顶距比较,差异无统计学意义[(26.7±4.1)mm,(27.7±3.4)mm,t=0.245,P=0.120]。2组患者随访时间6～12个月,中位数7.5个月。末次随访时,重建锁定接骨板联合PFNA组患者Harris髋关节评分高于PFNA组[(91.1±6.6)分,(83.1±6.4)分,t=3.036,P=0.005]。③安全性评价结果。重建锁定接骨板联合PFNA组1例发生主钉轻度上移,PFNA组2例发生主钉轻度上移、2例发生螺旋刀片后退及切出、1例发生主钉断裂。2组患者并发症发生率比较,差异无统计学意义(P=0.091)。结论:重建锁定接骨板联合PFNA内固定治疗合并外侧壁破裂的A3型老年股骨转子间骨折,与单纯PFNA内固定比较,患者下地活动早,住院时间和骨折愈合时间短,髋关节功能恢复好,且安全性相当。
Abstract:
Objective:To observe the clinical efficacy and safety of reconstruction locking plate and proximal femoral nail antirotation(PFNA)internal fixation in the treatment of type A3 femoral intertrochanteric fractures complicated with lateral wall rupture in elderly patients.Methods:The medical data of 40 elderly patients with type A3 femoral intertrochanteric fractures complicated with lateral wall rupture were retrospectively analyzed,including 20 cases treated with reconstruction locking plate and PFNA internal fixation(combination group)and 20 with PFNA internal fixation(PFNA group).The operation time,intraoperative blood loss,length of hospital stay,postoperative bed rest time,fracture healing time,decrease in femoral eccentric distance,tip apex distance(TAD),Harris Hip Score(HHS),and incidence of complications were compared between the two groups.Results:①General results.There was no significant difference in operation time and intraoperative blood loss between the two groups(114.12±12.52 vs 105.24±10.61 min,t=1.724,P=0.062; 309.12±18.37 vs 278.55±20.14 mL,t=1.956,P=0.059).The length of hospital stay and postoperative bed rest time of patients in the combination group were shorter than those in the PFNA group(11.0±1.5 vs 17.3±2.3 d,t=2.510,P=0.041; 26.4±5.5 vs 41.0±6.2 d,t=2.131,P=0.012).②Efficacy evaluation results.The fracture healing time of patients in the combination group was shorter than that in the PFNA group(9.8±1.2 vs 13.6±3.1 weeks,t=2.371,P=0.036),and the decrease in femoral eccentric distance was inferior to that in the PFNA group(0.3±0.2 vs 0.8±0.1 mm,t=1.658,P=0.020).There was no statistically significant difference in TAD between the two groups(26.7±4.1 vs 27.7±3.4 mm,t=0.245,P=0.120).Patients in both groups were followed up for 6-12 months,with a median of 7.5 months.At the last follow-up,the HHS of patients in the combination group was higher than that in the PFNA group(91.1±6.6 vs 83.1±6.4,t=3.036,P=0.005).③Safety evaluation results.In the combination group,one case underwent slight upward shift of the main nail.In the PFNA group,slight upward shift of the main nail occurred in two cases,spiral blade withdrawal and cutting out in two cases,and main nail fracture in one case.There was no significant difference in the incidence of complications between the two groups(P=0.091).Conclusion:Compared with PFNA internal fixation alone,reconstruction locking plate and PFNA internal fixation in the treatment of type A3 femoral intertrochanteric fractures complicated with lateral wall rupture in elderly patients can advance the postoperative bed rest time,shorten the length of hospital stay and fracture healing time,and improve the recovery of hip joint function,and the safety was equivalent.

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(收稿日期:2022-05-12 本文编辑:吕宁)

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