两种髓内钉固定骨质疏松股骨粗隆间骨折的比较

Comparison of two intramedullary nails for osteoporotic intertrochanteric fractures of the femur

摘要:

［目的］ 比较股骨近端抗旋转髓内钉 （proximal femoral nail anti-rotation, PFNA） 与 InterTAN 髓内钉联合抗骨质疏松治疗骨质疏松性粗隆间骨折的临床疗效。［方法］ 回顾性分析 2016 年 1 月—2019 年 1 月苏州大学第一附属医院骨科诊治的骨质疏松性股骨粗隆间骨折的老年患者的临床资料，共 102 例纳入本研究。依据术前医患沟通结果，53 例患者采用 PFNA 固定， 49 例采用 InterTAN 固定。比较两组围手术期、随访及影像学指标。［结果］两组患者均顺利完成手术，InterTAN 组手术时间、 切口长度、术中出血量均显著优于 PFNA 组（P<0.05）。所有患者均随访 12~32 个月，平均（22.52±6.41）个月。InterTAN 组在下地行走时间和完全负重活动时间均显著早于 PFNA 组（P<0.05）。随术后时间推移，两组髋伸屈 ROM、髋内旋-外旋 ROM 及 Harris 评分均显著增加，术后 6 个月和末次随访时 InterTAN 组上述指标均显著优于 PFNA 组 （P<0.05）。影像方面， InterTAN 组患者的复位优良率显著高于 PFNA 组 （P<0.05）。至末次随访时，两组患者骨折均愈合，无骨不连接。末次随访时 InterTAN 组股骨短缩显著小于 PFNA 组 （P<0.05），而 InterTAN 组的颈干角显著大于 PFNA 组 （P<0.05）。［结论］ 对于骨质疏松性粗隆间骨折，InterTAN 内固定的临床效果明显优于 PFNA。

Abstract:

[Objective] To compare the clinical efficacy of proximal femoral nail anti-rotation (PFNA) versus InterTAN intramedullary nail combined with anti-osteoporosis therapy for osteoporotic intertrochanteric fractures of the femur. [Methods] A total of 102 elderly pa- tients who underwent surgical treatment for osteoporotic intertrochanteric fracture of the femur in our hospital from January 2016 to January 2019 were included in this study. According to the results of preoperative doctor-patient communication, 53 patients received PFNA fixa- tion, while the other 49 patients received InterTAN fixation. The Perioperative, follow-up and imaging documents were compared between the two groups. [Results] All patients in both groups had surgical procedures performed successfully. The InterTAN group proved signifi- cantly superior to the PFNA group in terms of operation time, incision length and intraoperative blood loss (P＜0.05) . All patients were fol- lowed up for 12~32 months, with an average of (22.52±6.41) months. InterTAN group resumed walking and full weight bearing activity sig- nificantly earlier than PFNA group (P＜0.05) . The hip extension-flexion range of motion (ROM) , internal-external rotation ROM, and Har- ris score significantly increased postoperatively compared with those preoperatively in both groups (P＜0.05) , which in the InterTAN group were significantly better than those in the PFNA group at 6 months and the latest follow-up (P＜0.05) . With respect to imaging evaluation, the Inter TAN group got significantly higher rate of proper fracture reduction than the PFNA group (P＜0.05) . By the time of the latest fol- low-up, the fracture healing was achieved in all patients of both groups without nonunion. At the latest follow-up, the InterTAN group was significantly superior to the PFNA group in terms of femoral shortening and femoral neck-shaft angle (P＜0.05) . [Conclusion] For osteopo- rotic intertrochanteric fractures of the femur, the InterTAN used as internal fixation is considerably better than the PFNA.