Yu Weiguang, Zhang Xinchao, Zhu Xingfei, Hu Jun, Liu Yunjiang
Department of Orthopedics, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou City, Guangdong Province, 510700, China.
Department of Orthopaedics, Jinshan Hospital, Fudan University, Longhang Road No.1508, Jinshan District, Shanghai City, 201508, China.
J Orthop Surg Res. 2016 Jan 15;11:10. doi: 10.1186/s13018-016-0344-7.
The purpose of this study was to compare the clinical outcomes of elderly patients undergoing surgery for treatment of unstable trochanteric fractures receiving either proximal femoral nails anti-rotation-Asia (PFNA-IIs) or InterTan nails (ITs).
Between January 1, 2012, and June 31, 2015, 168 elderly patients with unstable intertrochanteric femur fractures enrolled in this study. The only intervention was ITs or PFNA-IIs of the unstable trochanteric femur fractures. Follow-up was at 1, 3, 6, and 12 months postoperatively and yearly thereafter. Intraoperative variables and postoperative complications were compared between the two groups.
Eight patients died, six were too infirmed for follow-up, and seven were lost during follow-up, leaving 147 patients meeting the criteria were evaluated at a mean follow-up of 20 months (range 16-26 months). Significant differences were observed between the two groups regarding local complications (IT, n = 10 vs. PFNA-II, n = 20), varus collapse of the head/neck or femoral shaft fractures at the tip of the nail (IT, n = 1 vs. PFNA-II, n = 8), femoral neck shortening (IT, 4.4 ± 1.1 mm vs. PFNA-II, 7.4 ± 2.4 mm), fracture healing time (IT, 14.7 ± 2.1 weeks vs. PFNA-II, 15.7 ± 2.4 weeks), femoral shaft fractures (IT, n = 0 vs. PFNA-II, n = 4), rotational loss of reduction (IT, n = 0 vs. PFNA-II, n = 9), lateral cortex fractures of the proximal femur or lateral greater trochanter fractures (IT, n = 8 vs. PFNA-II, n = 1), operative time (IT, 71.9 ± 6.8 min vs. PFNA-II, 52.3 ± 4.0 min), intraoperative blood loss (IT, 190.6 ± 6.0 mL vs. PFNA-II, 180.9 ± 10.8 mL), fluoroscopy time (IT, 5.0 ± 0.48 min vs. PFNA-II, 2.8 ± 0.33 min), hospital stay (IT, 9.65 ± 0.95 days vs. PFNA-II, 8.58 ± 0.93 days), cut-out (IT, n = 0 vs. PFNA-II, n = 6), and tip-apex distance (IT, 26.7 ± 0.91 mm vs. PFNA-II, 23.2 ± 1.22 mm). No significant differences existed for the other observation indexes (p > 0.05).
The IT nail may have more advantage for patients with unstable intertrochanteric fractures of the femur. However, for those complicated with lateral greater trochanter fractures, lateral cortex fractures of the proximal femurs, or unfit for surgery, the PFNA-II nail could be a good option. In addition, a large-sample, multicenter observational study is required for evaluation of its long-term efficacy, and optimal management strategies for specific unstable fracture patterns, different sorts of bone quality, and different levels of patient demand.
本研究的目的是比较接受股骨近端防旋髓内钉亚洲版（PFNA-II）或InterTan髓内钉（IT）治疗不稳定型股骨粗隆间骨折的老年患者的临床疗效。
2012年1月1日至2015年6月31日期间，168例老年不稳定型股骨粗隆间骨折患者纳入本研究。唯一的干预措施是对不稳定型股骨粗隆间骨折采用IT或PFNA-II。术后1、3、6和12个月进行随访，此后每年随访一次。比较两组的术中变量和术后并发症。
8例患者死亡，6例因身体过于虚弱无法随访，7例在随访期间失访，剩余147例符合标准的患者接受评估，平均随访20个月（范围16 - 26个月）。两组在局部并发症（IT组10例 vs. PFNA-II组20例）、钉尖处股骨头/颈或股骨干骨折的内翻塌陷（IT组1例 vs. PFNA-II组8例）、股骨颈缩短（IT组4.4±1.1mm vs. PFNA-II组7.4±2.4mm）、骨折愈合时间（IT组14.7±2.1周 vs. PFNA-II组15.7±2.4周）、股骨干骨折（IT组0例 vs. PFNA-II组4例）、复位旋转丢失（IT组0例 vs. PFNA-II组9例）、股骨近端外侧皮质骨折或大转子外侧骨折（IT组8例 vs. PFNA-II组1例）、手术时间（IT组71.9±6.8分钟 vs. PFNA-II组52.3±4.0分钟）、术中失血量（IT组190.6±6.0mL vs. PFNA-II组180.9±10.8mL）透视时间（IT组5.0±0.48分钟 vs. PFNA-II组2.8±0.33分钟）、住院时间（IT组9.65±0.95天 vs. PFNA-II组8.58±0.93天）、穿出（IT组0例 vs. PFNA-II组6例）以及尖顶距（IT组26.7±0.91mm vs. PFNA-II组23.2±1.22mm）方面存在显著差异。其他观察指标无显著差异（p>0.05）。
IT钉对于股骨不稳定型粗隆间骨折患者可能具有更多优势。然而，对于合并大转子外侧骨折、股骨近端外侧皮质骨折或不适合手术的患者，PFNA-II钉可能是一个不错的选择。此外，需要进行大样本、多中心观察性研究以评估其长期疗效以及针对特定不稳定骨折类型、不同骨质和不同患者需求水平的最佳治疗策略。
