老年股骨转子间骨折合并股骨外侧壁不坚固时股骨近端抗旋髓内钉与锁定加压钢板的疗效比较
[Effectiveness comparison of proximal femoral nail anti-rotation and locking compression plate for intertrochanteric fractures with lateral unsubstantial femoral wall in elderly patients].
作者信息
Shi Yongxin, Li Fuqin, Tan Wenfu, Liu Jinhua
机构信息
Department of Orthopaedics, First Affiliated Hospital, South China University, Hengyan Hunan, P.R. China.
出版信息
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2014 Oct;28(10):1199-203.
OBJECTIVE
To compare the effectiveness of the proximal femoral nail anti-rotation (PFNA) and locking compression plate (LCP) in the treatment of intertrochanteric fractures with the lateral unsubstantial femoral wall in elderly patients.
METHODS
Between May 2009 and August 2012, 69 elderly patients with intertrochanteric fractures with the lateral unsubstantial femoral wall were treated. Fractures were fixed with PFNA in 36 patients (PFNA group), and with LCP in 33 patients (LCP group). There was no significant difference in gender, age, injury cause, side of fracture, and fracture AO type between 2 groups (P > 0.05). The incision length, operation time, intraoperative blood loss, total blood loss, fluoroscopy frequency, time for ambulation, and early (within 3 months) and late (more than 12 months) complications were compared. Fracture healing was assessed according to X-ray reexamination, the function of the hip joint was assessed according to the Harris hip scoring system.
RESULTS
The incision length, operation time, intraoperative blood loss, and time for ambulation of PFNA group were significantly less than those of LCP group (P < 0.05), but the fluoroscopy frequency of PFNA group was significantly more than that of LCP group (P < 0.05). There was no significant difference in total blood loss between 2 groups (t = -1.686, P = 0.096). The patients were followed up 12-24 months in PFNA group and 15-30 months in LCP group. The X-ray reexamination revealed fracture healing at (12.667 ± 2.527) weeks in patients of PFNA group, and at (13.364 ± 1.194) weeks in the others of LCP group except 1 case of nonunion, showing no significant difference (t = -1.443, P = 0.154). There was no significant difference in Harris hip score between PFNA group (84.611 ± 7.076) and LCP group (81.785 ± 7.500) at 12 months after operation (t = 1.626, P = 0.109). The early complication rate and late complication rate were 16.7% (6/36) and 5.6% (2/36) in PFNA group and were 9.1% (3/33) and 9.1% (3/33) in LCP group, all showing no significant difference between 2 groups (χ2 = 0.871, P = 0.481; χ2 = 0.320, P = 0.665).
CONCLUSION
Both PFNA and LCP have good effectiveness in the,treatment of intertrochanteric fractures with the lateral unsubstantial femoral wall in the elderly patients. Each has its own advantages and disadvantages.
目的
比较股骨近端防旋髓内钉（PFNA）与锁定加压钢板（LCP）治疗老年股骨转子间骨折合并股骨外侧壁不完整的疗效。
方法
2009年5月至2012年8月，对69例老年股骨转子间骨折合并股骨外侧壁不完整患者进行治疗。36例患者采用PFNA固定（PFNA组），33例患者采用LCP固定（LCP组）。两组患者在性别、年龄、受伤原因、骨折部位及骨折AO分型方面差异无统计学意义（P>0.05）。比较两组患者的切口长度、手术时间、术中出血量、总出血量、透视次数、下地活动时间以及早期（3个月内）和晚期（12个月以上）并发症。根据X线复查评估骨折愈合情况，根据Harris髋关节评分系统评估髋关节功能。
结果
PFNA组的切口长度、手术时间、术中出血量及下地活动时间均显著少于LCP组（P<0.05），但PFNA组的透视次数显著多于LCP组（P<0.05）。两组患者的总出血量差异无统计学意义（t=-1.686，P=0.096）。PFNA组患者随访1224个月，LCP组患者随访1530个月。X线复查显示，PFNA组患者骨折愈合时间为（12.667±2.527）周，LCP组除1例骨不连患者外其余患者骨折愈合时间为（13.364±1.194）周，差异无统计学意义（t=-1.443，P=0.154）。术后12个月，PFNA组Harris髋关节评分为（84.611±7.076）分，LCP组为（81.785±7.500）分，差异无统计学意义（t=1.626，P=0.109）。PFNA组的早期并发症发生率和晚期并发症发生率分别为16.7%（6/36）和5.6%（2/36），LCP组分别为9.1%（3/33）和9.1%（3/33），两组差异均无统计学意义（χ2=0.871，P=0.481；χ2=0.320，P=0.665）。
结论
PFNA和LCP治疗老年股骨转子间骨折合并股骨外侧壁不完整均有良好疗效，各有优缺点。
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