两种股骨近端髓内钉固定股骨粗隆间骨折比较△

Comparison of two kinds of proximal femoral intramedullary nail for intertrochanteric femoral fractures in the elderly

摘要:

[目的] 比较股骨近端仿生髓内钉 (proximal femur bionic nail, PFBN) 与股骨近端抗旋髓内钉 (proximal femoral nail antirotation, PFNA) 固定老年股骨粗隆间骨折的近期疗效。[方法] 2020 年 10 月—2021 年 6 月，40 例老年股骨粗隆间骨折患者，随机分为两组，20 例采用 PFBN 固定，20 例采用 PFNA 固定。比较两组围手术期、随访与影像资料。[结果]两组患者均顺利完成手术，无严重并发症。两组术中出血量、切口愈合等级、住院时间的差异均无统计学意义(P＞0.05)。PFBN 组下地时间显著早于 PFNA 组(P＜0.05)，但手术时间和术中透视次数显著大于 PFNA 组(P＜0.05)。两组患者随访时间 6~9 个月，平均 (7.3±1.1) 个月，PFBN 组完全负重活动时间显著早于 PFNA 组 (P＜0.05)。随时间推移，两组 VAS 评分均显著降低 (P＜ 0.05)，而 Harris 评分及髋关节屈伸 ROM 和内-外旋 ROM 显著增加(P＜0.05)。在术后 1 个月时，PFBN 组的 Harris 评分显著优于 PFNA 组 (P＜0.05)。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 组颈干角显著大于 PFNA 组(P＜0.05)。[结论]股骨近端仿生髓内钉固定老年股骨粗隆间骨折更为稳定，允许患者早期下地行走，有利于骨折愈合，防止髋内翻发生。

Abstract:

[Objective] To compare the short-term clinical outcomes of proximal femur bionic nail (PFBN) versus proximal femoral nail anti-rotation (PFNA) for intertrochanteric fractures in the elderly. [Methods] From October 2020 to June 2021, a total of 40 elderly pa- tients with intertrochanteric fracture of femur were enrolled into this study, and randomly divided into two groups. Of them, 20 patients had fractures fixed with PFBN, while the remaining 20 patients were with PFNA. The perioperative period, follow-up and imaging data were compared between the two groups. [Results] All patients in both groups had operation performed successfully without serious complica- tions. There were no significant differences in intraoperative blood loss, incision healing grade and hospital stay between the two groups (P＞ 0.05) . The PFBN group resumed walking significantly earlier than that in PFNA group (P＜0.05) , but the former was significantly greater in terms of operation time and intraoperative fluoroscopy times than the latter (P＜0.05) . All the patients in both groups were followed up for 6~ 9 months, with an average of (7.3±1.1) months. The PFBN group resumed full weight-bearing activity significantly earlier than the PFNA group (P＜0.05) . The VAS score significantly decreased (P＜0.05) , while the Harris score, hip flexion-extension range of motion (ROM) and internal-external rotation ROM significantly increased in both groups over time (P＜0.05) . At 1 month after operation, PFBN group was sig- nificantly better than the PFNA group in term of Harris score (P＜0.05) . Radiographically, there were no significant differences in fracture reduction quality and fracture healing time between the two groups (P＞0.05) . At last follow-up, the PFBN group maintained significantly greater femoral neck-shaft angle than PFNA group (P＜0.05) . [Conclusion] This proximal femur bionic nail for proximal femoral intertro- chanteric fracture in elderly is more stable, allowing walking early postoperatively, which is beneficial to fracture healing and prevent coxa vara.