三维股骨近端髓内钉与PFNA固定粗隆间骨折比较

Comparison of three- dimensional proximal femoral intramedullary nail versus PFNA for femoral intertrochanteric fractures

摘要:

[目的] 探讨三维股骨近端髓内钉 （three-dimensional proximal femoral nail, 3DPFN） 与股骨近端防旋髓内钉 （proxi- mal femoral nail anti-rotation, PFNA） 治疗股骨粗隆间骨折 （femoral intertrochanteric fractures, FIF） 的临床疗效。[方法] 回顾性分析 2021 年 1 月—2023 年 4 月髓内钉固定 FIF 61 例患者的临床资料，依据术前医患沟通结果，30 例采用 3DPFN 固定，另外 31 例采用 PFNA 固定。对比两组围手术期、随访及影像指标。[结果]61 例患者均成功完成手术，术中无血管、神经损伤等严重并发症，3DPFN 组的手术时间 [(95.0±15.0) min vs (86.2±15.4) min, P=0.028]、术中透视次数 [(12.0±2.4) 次 vs (10.6±2.1) 次, P= 0.018] 均显著多于 PFNA 组，但是，前者下地行走时间显著早于后者 [(13.5±3.2) d vs (17.2±4.6) d, P＜0.001]。两组切口总长度、术中失血量、切口愈合等级、住院时间比较的差异均无统计学意义（P＞0.05）。平均随访时间（20.0±2.5）个月，3DPFN 组恢复完全负重活动时间显著早于 PFNA 组 [(62.3±6.4) d vs (70.2±10.0) d, P＜0.001]。随时间推移，两组术后 VAS 评分、Harris 评分、髋伸-屈活动度（range of motion, ROM）及髋内-外旋 ROM 均显著改善（P＜0.05），两组术后 6、12 个月上述指标比较的差异均无统计学意义（P＞0.05）。影像方面，两组 Baumgaertner 分级的差异无统计学意义（P＞0.05）。与术后即刻相比，术后 6 个月及末次随访时， 两组 FNSA、TAD 均无显著变化（P＞0.05），相应时间点，两组间 FNSA、TAD 的差异均无统计学意义（P＞0.05），两组骨折愈合时间的差异无统计学意义（P＞0.05）。[结论]3DPFN 治疗 FIF 能促进患者早日下地行走及完全负重活动，有利于机体恢复。

Abstract:

[Objective] To compare the clinical consequence of three-dimensional proximal femoral nail (3DPFN) versus proximal proximal femoral nail anti-rotation (PFNA) in the treatment of femoral intertrochanteric fractures (FIF). [Methods] A retrospective study was conducted on 61 patients who had FIF fixed by intramedullary nailing from January 2021 to April 2023. According to preoperative docent-patient communication, 30 patients had FIF fixed by 3DPFN, while the remaining 31 patients were by PFNA. The documents regarding periop- erative period, follow-up and imaging were compared between the two groups. [Results] All the 61 patients had operation performed successfully without vascular, nerve injury and other serious complications. Although the 3DPFN group consumed significantly longer operative time [(95.0±15.0) min vs (86.2±15.4) min, P=0.028] and intraoperative fluoroscopy times [(12.0±2.4) times vs (10.6±2.1) times, P=0.018] than the PFNA group, the former resumed ambulation significantly earlier than the latter [(13.5±3.2) days vs (17.2±4.6) days, P＜0.001]. There were no significant differences in total incision length, intraoperative blood loss, incision healing grade and hospital stay between the two groups (P＞0.05). The mean follow-up time was of (20.0±2.5) months, and the 3DPFN group returned to full weight-bearing activity significantly earlier than the PFNA group [(62.3±6.4) days vs (70.2±10.0) days, P＜0.001]. As time went on, the VAS and Harris scores, as well as hip extension-flexion range of motion (ROM) and internal-external rotation ROM were significantly improved in both groups (P＜0.05), which were not statistically significant between the two groups 6 and 12 months after surgery (P＞0.05). Radiographically, there was no a significant difference in Baumgaertner grade between the two groups (P＞0.05). Compared with those immediately after surgery, there were no significant changes in FNSA and TAD in both groups 6 months after surgery and at the last follow-up (P＞0.05). In addition, there were no significant differences in FNSA and TAD between the two groups at any corresponding time points (P＞0.05), and there were no a statistically significant differences in fracture healing time between the two groups (P＞0.05). [Conclusion] The 3DPFN in the treatment of FIF can pro-mote ambulation and complete weight-bearing activities as soon as possible, which is conducive to functional recovery.