[1]费国芳,费红良,王金法.两种内固定方法治疗老年不稳定性股骨转子间骨折的对比研究[J].中医正骨,2016,28(05):9-12.
　FEI Guofang,FEI Hongliang,WANG Jinfa.Comparison of two kinds of internal fixation for treatment of unstable femoral intertrochanteric fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(05):9-12.
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两种内固定方法治疗老年不稳定性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28卷
期数:
2016年05期
页码:
9-12
栏目:
临床研究
出版日期:
2016-05-20

文章信息/Info

Title:
Comparison of two kinds of internal fixation for treatment of unstable femoral intertrochanteric fractures in the aged
作者:
费国芳; 费红良; 王金法
浙江省湖州市南浔区人民医院,浙江 湖州 313009
Author(s):
FEI Guofang; FEI Hongliang; WANG Jinfa
Nanxun People's Hospital of Huzhou City,Huzhou 313009,Zhejiang
关键词:
髋骨折;  转子间骨折;  老年人;  骨质疏松;  骨板;  骨折固定术; 髓内;  疗效比较研究
Keywords:
hip fractures;  intertrochanteric fractures;  aged;  osteoporosis;  bone plates;  fracture fixation; intramedullary;  comparative effectiveness research
摘要:
目的:比较股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)固定和股骨近端解剖锁定接骨板(anatomic proximal femoral locking plate,ALP)固定治疗老年不稳定性股骨转子间骨折的临床疗效和安全性。方法:回顾性分析122例不稳定性股骨转子间骨折老年患者的病例资料,57例采用PFNA固定治疗(PFNA组)、65例采用ALP固定治疗(ALP组)。比较2组患者的部分负重时间、完全负重时间、骨折愈合时间、术后6个月时的Harris髋关节评分及并发症发生率。结果:PFNA组的部分负重时间、完全负重时间和骨折愈合时间均比ALP组短[(4.25±3.90)周,(5.57±2.90)周,t=1.988,P=0.049;(10.85±5.51)周,(13.75±6.75)周,t=2.576,P=0.011;(16.55±8.14)周,(20.50±9.86)周,t=2.393,P=0.018]; 术后6个月PFNA组的Harris评分高于ALP组[(87.30±9.21)分,(79.57±11.56)分,t=4.517,P=0.001]。至术后6个月时,PFNA组1例出现患侧下肢短缩,1例发生螺钉从股骨头切出,行人工髋关节置换术治疗; ALP组3例发生骨折延迟愈合,取出部分螺钉并植骨后愈合,2例发生钢板断裂,取出钢板后1例行关节置换术、1例以动力髁螺钉固定。2组患者的并发症发生率比较,差异无统计学意义(χ2=0.361,P=0.548)。结论:与ALP固定相比,采用PFNA固定治疗老年不稳定性股骨转子间骨折,患者可以更早地下床负重活动,获得更快的骨折愈合和更好的髋关节功能,二者的安全性相当。
Abstract:
Objective:To compare the clinical curative effects and safety of proximal femoral nail antirotation(PFNA)fixation versus anatomic proximal femoral locking plate(ALP)fixation for treatment of unstable femoral intertrochanteric fractures in the aged.Methods:The medical records of 122 aged patients with unstable femoral intertrochanteric fractures were analyzed retrospectively.Fifty-seven patients were treated with PFNA fixation(PFNA group),while the others were treated with ALP fixation(ALP group).The partial weight-bearing walk start time,complete weight-bearing walk start time,fracture healing time,Harris hip scores and complication incidences at six months after surgery were compared between the 2 groups.Results:The partial weight-bearing walk start time,complete weight-bearing walk start time and fracture healing time were shorter in PFNA group compared to ALP group(4.25+/-3.90 vs 5.57+/-2.90 weeks,t=1.988,P=0.049; 10.85+/-5.51 vs 13.75+/-6.75 weeks,t=2.576,P=0.011; 16.55+/-8.14 vs 20.50+/-9.86 weeks,t=2.393,P=0.018).The Harris hip scores at six months after surgery were higher in PFNA group compared to ALP group(87.30+/-9.21 vs 79.57+/-11.56 points,t=4.517,P=0.001).At six months after surgery,lower limb shortening in affected side(1)and screw protrusion from femoral head(1)were found in PFNA group,then artificial hip replacement were performed on the two patients.The delayed union of fractures were found in 3 patients in ALP group and the fractures healed after removing part of the screws and bone grafting.The plate breakage were found in 2 patients in ALP group,and one case was treated with joint replacement after removing the plate and the other one was treated with dynamic condylar screw fixation.There was no statistical difference in complication incidences between the two groups(χ2=0.361,P=0.548).Conclusion:Earlier weight-bearing activities,faster fracture healing and better hip joint function can be obtained after PFNA fixation compared to ALP fixation in aged patients with unstable femoral intertrochanteric fractures,while the two kinds of internal fixation are similar to each other in safety.

参考文献/References:

[1] Han N,Sun GX,Li ZC,et al.Comparison of proximal femoral nail antirotation blade and reverse less invasive stabilization system-distal femur systems in the treatment of proximal femoral fractures[J].Orthop Surg,2011,3(1):7-13.
[2] 管英.股骨近端锁定钢板术治疗老年股骨转子间骨折52例效果分析[J].中国老年学杂志,2011,31(10):1890-1891.
[3] Eberle S,Gabel J,Hungerer S,et al.Auxiliary locking plate improves fracture stability and healing in intertrochanteric fractures fixated by intramedullary nail[J].Clin Biomech(Bristol,Avon),2012,27(10):1006-1010.
[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] 蒋铭,徐锋,孙斌峰,等.股骨近端防旋髓内钉内固定配合中药内服治疗老年股骨转子间骨折[J].中医正骨,2014,26(7):17-19.
[6] Akan K,Cift H,Ozkan K,et al.Effect of osteoporosis on clinical outcomes in intertrochanteric hip fractures treated with a proximal femoral nail[J].J Int Med Res,2011,39(3):857-865.
[7] 朱求亮,颜茂华,赵立来,等.锁定加压钢板治疗骨质疏松性股骨转子间骨折[J].中国骨伤,2011,24(5):378-381.
[8] Zhou F,Zhang ZS,Yang H,et al.Less invasive stabilization system(LISS)versus proximal femoral nail anti-rotation(PFNA)in treating proximal femoral fractures:a prospective randomized study[J].J Orthop Trauma,2012,26(3):155-162.
[9] Tao R,Lu Y,Xu H,et al.Internal fixation of intertrochanteric hip fractures:a clinical comparison of two implant designs[J].ScientificWorldJournal,2013(11):834825.
[10] Chou DTS,Taylor AM,Boulton C,et al.Reverse oblique intertrochanteric femoral fractures treated with the intramedullary hip screw(IMHS)[J].Injury,2012,43(6):817-821.
[11] 张功林,葛宝丰.锁定钢板国外应用进展[J].中国骨伤,2009,22(8):643-645.
[12] 何钢,滕宇.股骨近端锁定钢板治疗转子间骨折失败原因分析[J].生物骨科材料与临床研究,2012,9(6):35-37.

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备注/Memo

备注/Memo:
通讯作者:王金法 E-mail:wa6042@163.com
更新日期/Last Update: 2016-10-30