Parker M J, Cawley S
Peterborough City Hospital, Peterborough and Stamford Hospital NHS Foundation Trust, Bretton Gate, Peterborough PE3 9GZ, UK.
Bone Joint J. 2017 Sep;99-B(9):1210-1215. doi: 10.1302/0301-620X.99B9.BJJ-2016-1279.R1.
To compare the outcomes for trochanteric fractures treated with a sliding hip screw (SHS) or a cephalomedullary nail.
A total of 400 patients with a trochanteric hip fracture were randomised to receive a SHS or a cephalomedullary nail (Targon PFT). All surviving patients were followed up to one year from injury. Functional outcome was assessed by a research nurse blinded to the implant used.
Recovery of mobility, as assessed by a mobility scale, was superior for those treated with the intramedullary nail compared with the SHS at eight weeks, three and nine months (p-values between 0.01 and 0.04), the difference at six and 12 months was not statistically significant (p = 0.15 and p = 0.18 respectively). The mean difference was around 0.4 points (0.3 to 0.5) on a nine point scale. Surgical time for the nail was four minutes less than that for the SHS (p < 0.001). Fracture healing complications were similar for the two groups. There were no statistically significant differences between implants for any other recorded outcomes including the need for post-operative blood transfusion, wound healing complications, general medical complications, hospital stay or mortality.
This study confirms the findings of a previous study that both methods of treatment produce similar results, although intramedullary fixation does result in marginally improved regain of mobility in comparison with the SHS. Cite this article: 2017;99-B:1210-15.
比较采用动力髋螺钉(SHS)或股骨近端髓内钉治疗股骨转子间骨折的疗效。
总共400例股骨转子间骨折患者被随机分组,分别接受动力髋螺钉或股骨近端髓内钉(Targon PFT)治疗。所有存活患者自受伤起随访1年。由对所使用的植入物不知情的研究护士评估功能结局。
根据活动量表评估,在8周、3个月和9个月时,与动力髋螺钉治疗组相比,髓内钉治疗组患者的活动恢复情况更好(p值在0.01至0.04之间),6个月和12个月时的差异无统计学意义(分别为p = 0.15和p = 0.18)。在9分制量表上,平均差异约为0.4分(0.3至0.5)。髓内钉的手术时间比动力髋螺钉少4分钟(p < 0.001)。两组的骨折愈合并发症相似。对于包括术后输血需求、伤口愈合并发症、一般医疗并发症、住院时间或死亡率在内的任何其他记录结局,植入物之间均无统计学显著差异。
本研究证实了先前一项研究的结果,即两种治疗方法产生相似的结果,尽管与动力髋螺钉相比,髓内固定确实能使活动恢复略有改善。引用本文:2017;99-B:1210-15。