[1]陈立和,麦伟发.加长型股骨近端防旋髓内钉联合钢缆内固定治疗股骨转子下粉碎性骨折的临床研究[J].中医正骨,2019,31(01):5-9.
　CHEN Lihe,MAI Weifa.Internal fixation with long proximal femoral nail antirotation and wirerope for treatment of femoral subtrochanteric comminuted fracture:a clinical study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(01):5-9.
点击复制

加长型股骨近端防旋髓内钉联合钢缆内固定治疗股骨转子下粉碎性骨折的临床研究()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期数:
2019年01期
页码:
5-9
栏目:
临床研究
出版日期:
2019-01-20

文章信息/Info

Title:
Internal fixation with long proximal femoral nail antirotation and wirerope for treatment of femoral subtrochanteric comminuted fracture:a clinical study
作者:
陈立和; 麦伟发
(广州市南沙区第六人民医院,广东 广州 511470)
Author(s):
CHEN Lihe; MAI Weifa
The Sixth People's Hospital of Nansha District,Guangzhou 511470,Guangdong,China
关键词:
髋骨折;  转子下骨折;  骨折; 粉碎性;  骨折固定术; 髓内;  骨固定钢丝;  骨板
Keywords:
hip fractures;  subtrochanteric fractures;  fractures; comminuted;  fracture fixation; intramedullary;  bone wires;  bone plates
摘要:
目的:观察加长型股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)联合钢缆内固定治疗股骨转子下粉碎性骨折的临床疗效及安全性。方法:将74例股骨转子下粉碎性骨折患者随机分为2组,每组37例。分别采用加长型PFNA联合钢缆内固定(髓内钉组)和股骨近端解剖锁定钢板(proximal femoral locking plate,PFLP)联合钢缆内固定(锁定钢板组)治疗。记录并比较两组患者的手术时间、术中出血量、术后完全负重开始时间、骨折愈合时间、Harris髋关节功能评分和并发症发生情况。结果:所有患者均获随访,随访时间6个月至2年,中位数8个月。髓内钉组有6例植骨,锁定钢板组有8例植骨。2组患者的手术时间比较,差异无统计学意义[(127.76±25.76)min,(133.28±22.68)min,t=3.226,P=0.317]; 髓内钉组的术中出血量少于锁定钢板组[(113.89±20.97)mL,(133.45±19.82)mL,t=5.537,P=0.037],术后完全负重开始时间和骨折愈合时间均短于锁定钢板组[(2.31±0.45)个月,(3.13±0.66)个月,t=6.089,P=0.034;(3.32±0.60)个月,(3.78±0.71)个月,t=5.411,P=0.042]。髓内钉组切口感染1例、髋内翻1例、深静脉血栓1例、内固定失败1例,锁定钢板组切口感染2例、髋内翻3例、深静脉血栓3例、骨折不愈合2例、内固定失败1例,髓内钉组的并发症发生率低于锁定钢板组(χ2=4.097,P=0.043)。3例切口感染者,采用抗生素治疗后均治愈; 4例髋内翻畸形者,2例行楔形截骨矫正术后髋关节功能恢复,2例未进行治疗; 4例深静脉血栓形成者,1例行抗凝治疗、2例行溶栓治疗、1例穿戴弹力袜治疗,均好转; 2例骨折不愈合者,行髓内钉固定联合异体骨植骨后骨折愈合; 2例内固定失败者,行翻修手术后效果良好。术后6个月采用Harris髋关节功能评分评价综合疗效,髓内钉组(87.64±16.37)分,优19例、良12例、可4例、差2例; 锁定钢板组(81.39±12.86)分,优11例、良15例、可4例、差7例; 髓内钉组的综合疗效优于锁定钢板组(Z=-2.061,P=0.039)。结论:与PFLP联合钢缆内固定治疗相比,加长型PFNA联合钢缆内固定治疗股骨转子下粉碎性骨折,术中出血量少、术后可早期完全负重、骨折愈合时间短、综合疗效好、安全性高。
Abstract:
Objective:To observe the clinical curative effects and safety of internal fixation with long proximal femoral nail antirotation(PFNA)and wirerope for treatment of femoral subtrochanteric comminuted fracture.Methods:Seventy-four patients with femoral subtrochanteric comminuted fractures were randomly divided into 2 groups,37 cases in each group.The patients were treated with internal fixation with long PFNA and wirerope(intramedullary nail group)and internal fixation with proximal femoral locking plate(PFLP)and wirerope(locking plate group)respectively.The operative time,intraoperative blood loss,postoperative full weight-bearing start time,fracture healing time,Harris hip function scores and complication incidences were recorded and compared between the 2 groups.Results:All patients in the 2 groups were followed up for 6-24 months with a median of 8 months.Bone grafting was performed on 6 patients in intramedullary nail group and 8 patients in locking plate group.There was no statistical difference in operative time between the 2 groups(127.76+/-25.76 vs 133.28+/-22.68 min,t=3.226,P=0.317).The intraoperative blood loss was less,and the postoperative full weight-bearing start time and fracture healing time were shorter in intramedullary nail group compared to locking plate group(113.89+/-20.97 vs 133.45+/-19.82 mL,t=5.537,P=0.037; 2.31+/-0.45 vs 3.13+/-0.66 months,t=6.089,P=0.034; 3.32+/-0.60 vs 3.78+/-0.71 months,t=5.411,P=0.042).Incision infection(1),coxa vara(1),deep venous thrombosis(1)and failed internal fixation(1)were found in intramedullary nail group; while incision infection(2),coxa vara(3),deep venous thrombosis(3),fracture nonunion(2)and failed internal fixation(1)were found in locking plate group.The complication incidence was lower in intramedullary nail group compared to locking plate group(χ2=4.097,P=0.043).The three patients with incision infection were cured after antibiotic treatment.Two patients with coxa vara deformity were treated with wedge-shaped osteotomy and their hip functions were recovered,and the other 2 patients with coxa vara deformity were untreated.Anticoagulant therapy,thrombolytic therapy and elastic socks therapy were performed on 1,2 and 1 patient with deep vein thrombosis respectively,and their deep vein thrombosis were improved.Combination therapy of intramedullary nail fixation and allogeneic bone grafting were performed on the 2 patients with nonunion of fracture,and the fractures were healed.Revision surgery was performed on the 2 patients with failed internal fixation and they obtained a good result.The total clinical curative effects were evaluated according to Harris hip function scores at 6 months after the surgery,and the scores were 87.64+/-16.37 points in intramedullary nail group and 81.39+/-12.86 points in locking plate group.Nineteen patients obtained an excellent result,12 good,4 fair and 2 poor in intramedullary nail group; while 11 patients obtained an excellent result,15 good,4 fair and 7 poor in locking plate group.The intramedullary nail group surpassed the locking plate group in the total clinical curative effect(Z=-2.061,P=0.039).Conclusion:Internal fixation with long PFNA and wirerope has the advantages of less intraoperative blood loss,earlier postoperative full weight-bearing activities,shorter fracture healing time,better total clinical curative effect and higher safety compared to internal fixation with PFLP and wirerope in treatment of femoral subtrochanteric comminuted fracture.

参考文献/References:

[1] TOMÁS J,TEIXIDOR J,BATALLA L,et al.Subtrochanteric fractures:treatment with cerclage wire and long intramedullary nail[J].J Orthop Trauma,2013,27(7):157-160.
[2] 孟位明,李彦眉,许红生,等.股骨转子下骨折植入物髓外及髓内固定治疗的规范化[J].中国组织工程研究,2014,18(22):3587-3592.
[3] 秦强,殷潇凡.加长防旋股骨近端髓内钉治疗SeinsheimerⅡ～Ⅴ型股骨转子下骨折[J].临床骨科杂志,2015,18(3):275.
[4] 孙哲,刘绍灵,邓进.股骨转子下骨折的治疗进展[J].创伤外科杂志,2018,20(5):396-398.
[5] SEINSHEIMER F.Subtrochanteric fractures of the femur[J].J Bone Joint Surg Am,1978,60(3):300-306.
[6] 张嘉,翁习生.股骨转子下骨折的诊断和治疗[J].中国骨与关节外科,2008,1(1):77-81.
[7] HARRIS WH.Traumatic arthritis of the hip after dislocation and acetabular fractures:treatment by mold arthroplasty.An end-result study using a new method of result evaluation[J].J Bone Joint Surg Am,1969,51(4):737-755.
[8] 赵海生,徐耀增,王贵贤,等.股骨近端防旋髓内钉治疗股骨转子下骨折[J].中国组织工程研究,2013,17(48):8368-8373.
[9] SAINI P,KUMAR R,SHEKHAWAT V,et al.Biological fixation of comminuted subtrochanteric fractures with proximal femur locking compression plate[J].Injury,2013,44(2):226-231.
[10] 王少林,谭祖键,周明全,等.解剖型锁定钢板固定治疗累及股骨干的转子间或转子下骨折[J].中华骨科杂志,2012,32(7):626-630.
[11] 张雷炎,蒋建农,王勇,等.有限切开复位钛缆环扎结合髓内钉固定治疗股骨转子下骨折[J].临床骨科杂志,2017,20(1):89-90.
[12] 白涛,呼瑞,张文生,等.加长型PFNA-Ⅱ和DHS治疗老年骨质疏松性股骨转子下骨折临床疗效及CRP、IL-6、Harris评分变化[J].陕西医学杂志,2018,47(1):81-83.
[13] 朱龙,闫英杰,程战伟,等.PFLP与PFNA微创治疗老年不稳定型股骨粗隆间骨折的对比[J].实用骨科杂志,2014,20(10):935-938.
[14] 洪俊毅,毕大卫,许冠华,等.加长PFNA治疗股骨转子下骨折临床疗效分析[J].浙江临床医学,2017,19(6):1058-1060.

相似文献/References:

[1]温超海,何忠,李永斌,等.闭合复位伽玛钉改良成锁定支架内固定治疗 老年股骨转子间骨折[J].中医正骨,2015,27(11):32.
[2]孙群周,阮成群,李光明,等.股骨近端防旋髓内钉内固定治疗 老年不稳定型股骨转子间骨折[J].中医正骨,2015,27(10):20.
[3]方策,倪新宇,王宏伟,等.迟氏正骨手法复位单臂外固定支架固定治疗 老年股骨转子间骨折[J].中医正骨,2015,27(10):22.
[4]赵云昌.人工股骨头置换治疗老年粉碎性股骨转子间骨折[J].中医正骨,2015,27(08):31.
[5]姜自伟,黄枫,郑晓辉,等.老年股骨转子间骨折患者的围手术期风险评估与控制[J].中医正骨,2015,27(08):33.
[6]倪新宇,方策.外固定器治疗股骨转子间骨折的研究进展[J].中医正骨,2015,27(07):48.
[7]张明强.生物型加长柄半髋关节置换术治疗 高龄不稳定股骨转子间骨折疗效观察[J].中医正骨,2015,27(02):56.
[8]李书良,李启义,李建明,等.锁定钢板内固定联合自体髂骨植骨治疗 股骨近端粉碎性骨折[J].中医正骨,2015,27(05):31.
[9]王智勇,陈柯,田可为,等.联合应用摇杆技术和钳夹技术微创治疗股骨转子部骨折[J].中医正骨,2015,27(05):36.
[10]郑艳峰,吴勋,周荣昌,等.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,2015,27(04):24.
　ZHENG Yanfeng,WU Xun,ZHOU Rongchang,et al.A comparative study of proximal femoral nail antirotation internal fixation versus dynamic hip screw internal fixation for treatment of intertrochanteric fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):24.
[11]郭甲瑞,余进伟,陈旭.股骨近端防旋髓内钉内固定治疗股骨转子下骨折[J].中医正骨,2016,28(06):48.
[12]王瑞雄,陈夏平,吴天然,等.非骨科牵引床上手法闭合复位小切口钳夹固定在股骨转子下骨折股骨近端防旋髓内钉内固定术中的应用[J].中医正骨,2017,29(03):45.

更新日期/Last Update: 2019-07-11