改良小切口股骨近端髓内钉固定转子间骨折

Modified small incision used in proximal femoral nail anti-rotation for fixation of femoral intertrochanteric fractures

摘要:

[目的]探讨改良小切口股骨近端防旋髓内钉（proximal femoral nail anti-rotation, PFNA）治疗股骨转子间骨折的临床疗效。[方法]2019 年 1 月—2021 年 1 月对 84 例股骨转子间骨折采用 PFNA 术治疗，依据术前医患沟通结果，44 例采用改良小切口 PFNA 术（小切口组），40 例采用常规切口 PFNA 术（常规组），比较围手术期资料以及随访结果。[结果]两组均顺利完成手术，无严重术中并发症。小切口组切口总长度 [(5.3±1.3) cm vs (7.0±1.4) cm, P＜0.001]、术中出血量 [(88.3±19.2) ml vs (106.3±22.4) ml, P＜0.001]、透视次数 [(12.0±2.5) 次 vs (15.2±3.2) 次, P＜0.001] 均显著优于常规组。但是，两组间手术时间、下地行走时间、住院时间、切口愈合等级的差异无统计学意义（P＞0.05）。两组均随访 12 个月以上，两组恢复完全负重时间的差异无统计学意义（P＞0.05）。随着时间推移，两组 VAS 评分逐渐减少，Harris 评分、髋伸屈 ROM、髋内-外旋 ROM 逐渐增加（P＜ 0.05）。术后相应时间点两组间 VAS 评分、Harris 评分、髋伸屈 ROM、髋内-外旋 ROM 的差异均无统计学意义 （P＞0.05）。影像方面，两组骨折复位质量、骨折愈合时间差异无统计学意义 （P＞0.05），两组术后即刻、末次随访颈干角均显著大于术前 （P＜0.05），相应时间点，两组间颈干角的差异均无统计学意义 （P＞0.05）。至末次随访时两组患者骨折均愈合，无内固定断裂、移位等不良影像改变。[结论]改良小切口 PFNA 术治疗股骨转子间骨折能减少术中创伤，临床效果与常规切口相当。

Abstract:

[Objective] To investigate the clinical outcomes of proximal femoral nail anti-rotation (PFNA) placed through a modified small incision in the treatment of femoral intertrochanteric fractures in the elderly. [Methods] A total of 84 patients received PFNA for fem- oral intertrochanteric fractures in our hospital from January 2019 to January 2021. According to preoperative doctor-patient communica- tion, 44 patients had PFNA placed though the modified small incision (SI group), while the other 40 patients were treated with conventional incision (CI group). The documents regarding the perioperative period and follow- up and radiographs were compared between the two groups. [Results] All patients in both groups had PFNA performed successfully without serious intraoperative complications. The SI group was proved significantly superior to the CI group in terms of the total incision length [(5.3±1.3) cm vs (7.0±1.4) cm, P＜0.001], intraopera- tive blood loss [(88.3±19.2) ml vs (106.3±22.4) ml, P＜0.001], the times of fluoroscopy [(12.0±2.5) times vs (15.2±3.2) time, P＜0.001], but there were no statistically significant differences in operation time, postoperative ambulation time, hospital stay and incision healing grade between the two groups (P＞0.05). The follow-up period lasted for more than 12 months, and there was no significant difference in the time to resume full weight-bearing activity between the two groups (P＞0.05). The VAS score decreased significantly (P＜0.05), while the Harris score, hip extension-flexion ROM and hip internal-external rotation ROM increased significantly in both groups over time (P＜0.05), where- as which were not statistically significant between the two groups at any time points accordingly after surgery (P＞0.05). Regarding to imag- ing, there were no significant differences in the reduction quality and healing time between the two groups (P＞0.05). The neck-shaft angle immediately postoperatively and at the last follow-up was significantly greater than that before surgery in both groups (P＜0.05). However, there was no significant difference in the neck-shaft angle between the two groups at any matching time points (P＞0.05). By the time of the last follow-up, all patients in both groups got fractures healed without internal fixation loosening and other adverse image changes. [Conclu- sion] This modified small incision used for placement of PFNA for femoral intertrochanteric fractures does reduce intraoperative trauma,and get the clinical results comparable to conventional incision.