骨水泥强化髓内钉固定骨质疏松性股骨粗隆间骨折△

Bone cement augmented proximal femoral nail anti-rotation for internal fixation of osteoporotic femoral intertrochanteric fractures

摘要:

［目的］ 探讨骨水泥强化型股骨近端抗旋转髓内钉 （proximal femoral nail antirotation, PFNA） 固定骨质疏松性股骨粗隆间骨折的临床效果。［方法］回顾性分析 2016 年 6 月—2020 年 6 月手术治疗骨质疏松性股骨粗隆间骨折 99 例患者的临床资料。依据医患沟通结果，42 例采用骨水泥强化型 PFNA 固定，57 例采用人工股骨头置换 （hemiarthroplasty, HA）。对比两组患者围手术期、随访和影像资料。［结果］两组患者均顺利完成手术，无严重并发症发生。两组手术时间、切口愈合等级、术后下地时间及住院时间的差异均无统计学意义（P>0.05）。两组患者均获随访，平均随访时间（24.52±8.65）个月。随着时间的推移，两组 VAS 评分显著下降 （P<0.05），而 Harris 评分、髋伸屈 ROM、内-外旋转 ROM 均显著增加 （P<0.05）。相应时间点， 两组间 VAS 评分、Harris 评分、髋伸屈 ROM、内-外旋转 ROM 差异均无统计学意义（P>0.05）。两组完全负重活动时间差异无统计学意义 （P>0.05）。影像方面，末次随访时，两组股颈干角、股骨头偏距，股骨长度与健侧比较的差异均无统计学意义 （P>0.05）。［结论］ 骨水泥强化型 PFNA 固定骨质疏松性股骨粗隆间骨折有利于患者早期恢复下地行走和负重活动，临床效果与 HA 相近。

Abstract:

[Objective] To evaluate the clinical outcomes of bone cement augmented proximal femoral nail anti-rotation (PFNA) for in- ternal fixation of osteoporotic femoral intertrochanteric fractures. [Methods] A retrospective study was conducted on 99 patients who re- ceived surgical treatment for osteoporotic femoral intertrochanteric fractures from June 2016 to June 2020. Based on doctor-patient commu- nication, 42 patients received cement-augmented PFNA fixation, while the other 57 patients underwent hip hemiarthroplasty (HA) . The perioperative, follow-up and imaging data were compared between the two groups. [Results] All the patients in both groups had correspond- ing surgical procedures performed successfully without serious complications, with no significant differences in terms of operative time, inci- sion healing, postoperative ambulation time and hospital stay between the two groups (P＞0.05) . As time went during the follow up lasted for (24.52±8.65) months on an average, the VAS score decreased significantly (P＜0.05) , whereas the Harris score, hip flexion-extension range of motion (ROM) , and internal-external rotation ROM significantly increased in both groups (P＜0.05) . However, there were no significant differences in abovesaid items between the two groups at any matching time points (P＞0.05) . In addition, there was no a significant differ- ence in the time to resume full-weight bearing activity between the two groups (P＞0.05) . Radiographically, there were no statistically signif- icant differences in femoral shaft angle, femoral head offset, or femoral length compared with the healthy side between the two groups at the latest follow up (P＞0.05) . [Conclusion] This cement-augmented PFNA fixation of osteoporotic femoral intertrochanteric fractures is benefi- cial to the early recovery of walking and weight-bearing activities, and achieves the clinical outcomes similar to the HA.