两种股骨近端髓内钉固定不稳定股骨粗隆间骨折△（开放获取）

Two types of proximal femoral intramedullary nail fixation for unstable intertrochanteric fractures of the femur (OA)

摘要:

[目的]比较股骨近端仿生髓内钉（proximal femur bionic nail, PFBN）与 InterTAN 髓内钉治疗老年不稳定型股骨粗隆间骨折的疗效。[方法] 回顾性分析 2021 年 6 月—2022 年 12 月本院手术治疗的 35 例老年不稳定型股骨粗隆间骨折患者的临床资料。根据术前医患沟通结果，16 例采用 PFBN 固定，19 例采用 InterTAN 固定。比较两组围手术期、随访及影像学资料。 [结果] 所有患者均顺利完成手术。虽然 PFBN 组手术时间 [(111.6±15.9) min vs (98.9±15.9) min, P=0.025]、切口长度 [(11.9± 0.9) cm vs (10.9±1.1) cm, P=0.006] 、术中透视次数 [(19.2±2.6) 次 vs (14.6±1.9) 次, P＜0.001]和术中失血量 [(145.6±2.6) ml vs (120.5±31.1) ml, P=0.043] 显著大于 InterTAN 组，但前者术后下地行走时间显著早于后者 [(19.1±2.0) d vs (23.8±3.2) d, P＜0.001]。两组患者随访时间平均（14.7±2.6）个月，PFBN 组恢复完全负重活动时间显著早于 InterTAN 组 [(51.6±4.9) d vs (66.7±7.3) d, P＜0.001]。随时间的推移，两组 VAS 评分显著下降 （P＜0.05），而 Harris 评分、髋伸屈 ROM、内-外旋 ROM 均显著增加 （P＜0.05）。PFBN 组术后 1 个月 [(64.9±5.4) vs (55.0±5.7), P＜0.001] 和术后 3 个月 [(73.1±4.8) vs (67.7±5.3), P=0.004] 的 Harris 评分均显著优于 InterTAN 组。影像方面，两组骨折复位质量、骨折愈合时间的差异均无统计学意义（P＞0.05）。末次随访时，PFBN 组股骨颈干角（femoral neck-shaft angle, FNSA） 显著大于 InterTAN 组 （P＜0.05），而尖项距 （tip-apex distance, TAD） 显著小于 InterTAN 组 （P＜ 0.05）。[结论]采用 PFBN 治疗老年不稳定型股骨粗隆间骨折缩短了卧床时间，允许患者早期下地及负重行走，促进了机体功能的恢复，减少髋内翻。

Abstract:

[Objective] To compare the efficacy of proximal femoral bionic nail (PFBN) and InterTAN intramedullary nail for unstable intertrochanteric fractures of the femur in the elderly. [Method] A retrospective analysis was conducted on 35 elderly patients with unstable intertrochanteric fractures of the femur who underwent surgical treatment in our hospital from June 2021 to December 2022. According to preoperative doctor-patient communication, 16 cases had the fractures fixed with the PFBN, while the remaining 19 cases were fixed with the InterTAN. The perioperative, follow-up, and imaging data were compared between two groups. [Result] All patients in both groups had corresponding surgical procedure completed successfully. Although the PFBN group had significantly greater surgical time [(111.6±15.9) min vs (98.9±15.9) min, P=0.025], incision length [(11.9±0.9) cm vs (10.9±1.1) cm, P=0.006], intraoperative fluoroscopy frequency [(19.2 ± 2.6) times vs (14.6±1.9) times, P＜0.001], and the intraoperative blood loss [(145.6±2.6) ml vs (120.5±31.1) ml, P=0.043], compared to the InterTAN group, the former had significantly earlier postoperative walking time than the latter [(19.1±2.0) d vs (23.8±3.2) d, P＜0.001] . The follow-up period lasted for (14.7±2.6) months in a mean , and the PFBN group had a significantly earlier recovery of full weight-bearing activity than the InterTAN group [(51.6±4.9) days vs (66.7±7.3) days, P＜0.001]. The VAS scores significantly decreased (P＜0.05), while Harris scores, hip flexion-extension ROM, and internal-external rotation ROM significantly increased in both groups over time (P＜0.05). The PFBN group was significantly better than the InterTAN group regarding Harris score [(64.9 ± 5.4) vs (55.0±5.7), P＜0.001] 1 month postoperatively, and [(73.1±4.8) vs (67.7±5.3), P=0.004] 3 months after operation. As for imaging, there was no statistically significant difference in the quality of fracture reduction and fracture healing time between the two groups (P＞0.05). At the last follow-up, the PFBN group remained significantly greater the femoral neck shaft angle (FNSA) (P＜0.05), while significantly less the tip apex distance (TAD) than the InterTAN group (P＜0.05). [Conclusion] The PFBN used for unstable intertrochanteric fractures in the elderly does shorten bed rest time, allows walking under weight early, promotes the recovery of body function, and reduces hip varus.