Department of Orthopedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200072, China.
Biomed Res Int. 2021 Feb 8;2021:8875370. doi: 10.1155/2021/8875370. eCollection 2021.
Due to the instability of unstable intertrochanteric fractures, the selection of a suitable internal fixation has always been a challenge for orthopedic surgeons. This study is aimed at comparing the clinical efficacy of PFNA combined with cerclage cable and without cerclage cable and finally recommend a stable internal fixation method to provide the basis for clinical therapy. From January 2014 to January 2018, we retrospectively analyzed all cases of unstable intertrochanteric fractures who received treatment in the Orthopedics Department of our hospital and finally screened 120 cases, 51 of whom were treated with cerclage cable, 69 without cerclage cable. The follow-up period was one year. HHS, BI, and RUSH scores were given within the specified time. We divided the patients into the PFNA+cable (PFNA combined with cerclage cable) group and the PFNA group. The time of fracture healing and weight-bearing in the PFNA+cable group was shorter than that in the PFNA group. With regard to HHS, BI, and RUSH, the PFNA+cable group was higher than the PFNA group at 1 month, 3 months, 6 months, and 12 months after operation. For HHS rating, the PFNA+cable group has a higher excellent rate than the PFNA group, which was 96.1% and 84.1%, respectively. All the results mentioned above were statistically significant. Compared with the group without cerclage cable, the application of cerclage cable can reduce the incidence of complications. From the comparison between the two groups, it can be seen that the surgical method of PFNA combined with cerclage cable can not only help to improve the stability of fracture reduction, shorten the time of fracture healing and postoperative weight-bearing, and significantly improve patients' self-care ability but also reduce the incidence of postoperative complications. Therefore, we think PFNA combined with cerclage cable is a good choice.
由于不稳定型转子间骨折的不稳定性，选择合适的内固定一直是骨科医生面临的挑战。本研究旨在比较 PFNA 联合环扎线与不联合环扎线的临床疗效，最终推荐一种稳定的内固定方法，为临床治疗提供依据。
2014 年 1 月至 2018 年 1 月，我们回顾性分析了我院骨科收治的所有不稳定型转子间骨折患者，最终筛选出 120 例患者，其中 51 例行环扎线治疗，69 例行非环扎线治疗。随访时间为 1 年。在规定时间内给予 HHS、BI、RUSH 评分。将患者分为 PFNA+cable（PFNA 联合环扎线）组和 PFNA 组。PFNA+cable 组的骨折愈合时间和负重时间短于 PFNA 组。术后 1 个月、3 个月、6 个月、12 个月时，HHS、BI、RUSH 评分，PFNA+cable 组均高于 PFNA 组。在 HHS 评分方面，PFNA+cable 组的优良率高于 PFNA 组，分别为 96.1%和 84.1%。所有结果均有统计学意义。与无环扎线组相比，环扎线的应用可降低并发症发生率。
从两组比较来看，PFNA 联合环扎线的手术方法不仅有助于提高骨折复位的稳定性，缩短骨折愈合和术后负重时间，显著提高患者自理能力，而且还降低了术后并发症的发生率。因此，我们认为 PFNA 联合环扎线是一种较好的选择。
