在伴有外侧壁受损的股骨转子间骨折中，股骨近端髓内钉与股骨远端逆行锁定钢板的比较：一项随机对照试验
Proximal femoral nails compared with reverse distal femoral locking plates in intertrochanteric fractures with a compromised lateral wall; a randomised controlled trial.
作者信息
Haq Rehan Ul, Manhas Vikrant, Pankaj Amite, Srivastava Amit, Dhammi Ish Kumar, Jain Anil Kumar
机构信息
Department of Orthopaedics, University College of Medical Sciences and GTB Hospital, New Delhi, India,
出版信息
Int Orthop. 2014 Jul;38(7):1443-9. doi: 10.1007/s00264-014-2306-1. Epub 2014 Mar 22.
PURPOSE
There is no consensus about the best option of internal fixation for unstable intertrochanteric fractures. The aim of the present study was to compare proximal femoral nail (PFN) with contralateral reverse distal femoral locking compression plate (reverse-DFLCP) in the management of unstable intertrochanteric fractures with compromised lateral wall.
METHOD
In a randomized controlled study, from November 2011 to October 2012, 40 patients with unstable intertrochanteric fractures with compromised lateral wall (AO 31A 2.2 to 3.3) had osteosynthesis by PFN (n = 20) or reverse-DFLCP (n = 20). Intra-operative variables compared were duration of surgery, blood loss during surgery, fluoroscopy time and surgeons perception of the surgery. Patients were followed up clinically for a minimum of one year. Functional outcome was assessed by Parker Palmer mobility score (PPMS), Harris hip score (HHS), and Short Form-12. Failure was defined as any condition which would necessitate revision surgery with change of implant.
RESULTS
Duration of surgery (p = 0.022), blood loss during surgery (p = 0.008) and fluoroscopy time (p = 0.0001) were significantly less in the PFN group than in the reverse-DFLCP group. No significant difference was found in type of reduction, difficulty in reduction and surgeon's perception of surgery. The PFN group had better functional outcome than the reverse-DFLCP group. HHS for the PFN group was 81.53 ± 13.21 and for the reverse-DFLCP group it was 68.43 ± 14.36 (p = 0.018). SF-12 physical (p = 0.002) and mental component (p = 0.007) scores in the PFN group was significantly better than in the reverse-DFLCP group. There was one failure in the PFN group as compared to six in the reverse-DFLCP group (p = 0.036).
CONCLUSION
Due to favourable intra-operative variables, better functional outcome and lower failure rates, we conclude that PFN is a better implant than reverse-DFLCP for intertrochanteric fractures with compromised lateral wall.
目的
对于不稳定型转子间骨折的最佳内固定选择尚无共识。本研究的目的是比较股骨近端髓内钉（PFN）与对侧股骨远端锁定加压钢板（反向DFLCP）在治疗伴有外侧壁受损的不稳定型转子间骨折中的效果。
方法
在一项随机对照研究中，2011年11月至2012年10月期间，40例伴有外侧壁受损的不稳定型转子间骨折（AO 31A 2.2至3.3）患者分别接受PFN（n = 20）或反向DFLCP（n = 20）进行骨合成。比较的术中变量包括手术时间、术中失血量、透视时间以及外科医生对手术的感受。对患者进行至少一年的临床随访。通过帕克·帕尔默活动度评分（PPMS）、哈里斯髋关节评分（HHS）和简明健康调查量表12项（SF - 12）评估功能结局。失败定义为任何需要更换植入物进行翻修手术的情况。
结果
PFN组的手术时间（p = 0.022）、术中失血量（p = 0.008）和透视时间（p = 0.0001）均显著少于反向DFLCP组。在复位类型、复位难度和外科医生对手术的感受方面未发现显著差异。PFN组的功能结局优于反向DFLCP组。PFN组的HHS为81.53±13.21，反向DFLCP组为68.43±14.36（p = 0.018）。PFN组的SF - 12身体（p = 0.002）和精神成分（p = 0.007）评分显著优于反向DFLCP组。PFN组有1例失败，而反向DFLCP组有6例（p = 0.036）。
结论
由于术中变量良好、功能结局更好且失败率更低，我们得出结论，对于伴有外侧壁受损的转子间骨折，PFN是比反向DFLCP更好的植入物。
Zotero 插件