PFNA 治疗老年股骨转子间骨折伴或不伴外侧壁骨折：一项回顾性队列研究。
The PFNA in treatment of intertrochanteric fractures with or without lateral wall fracture in elderly patients: a retrospective cohort study.
机构信息
Trauma Medical Center, Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
West China Women's and Children's Hospital, No. 17 People's South Road, Chengdu, Sichuan, China.
出版信息
Eur J Med Res. 2023 Sep 27;28(1):380. doi: 10.1186/s40001-023-01332-y.
BACKGROUND
There is no consensus about intertrochanteric fractures with lateral wall treated with intramedullary nail-proximal femoral nail antirotation (PFNA). The aim of the present study was to compare function outcomes between lateral wall and no lateral wall fractures after surgery by PFNA.
METHODS
This retrospective study evaluated patients with or without lateral wall fractures who underwent PFNA between January 2015 and June 2018. The operative time, intraoperative blood loss, time to fracture healing, complications and functional outcomes qualified by Harris hip score and Parker - Palmer mobility score (PPMS) were compared between the two groups.
RESULTS
Two groups were comparable with regard to patient age, sexual distribution, mechanism of injury, fracture type, body mass index (BMI), Time to surgery, American Society of Anesthesiologists (ASA) score and quality of reduction. The incomplete group had a longer operation time (54.1 ± 8.74 min vs. 51.0 ± 9.86 min) and more intraoperative blood loss (228.4 ± 48.8 ml vs. 151.3 ± 43.5 ml) in comparison with the control group (P < 0.01). Regarding functional outcome, the HHSs of the two groups were 76.2 ± 11.6 vs 75.6 ± 12.5 at the 3 months (P = 0.603), 81.9 ± 9.4 vs 82.6 ± 8.7 at the six months (P = 0.224), 83.8 ± 6.6 vs 84.5 ± 6.0 at the twelve months 85.2 ± 5.5 vs 86.0 ± 5.8 at the twenty-four months (P > 0.05), respectively. Similar results were obtained about PPMS. We found no difference in Weight bearing time, Time of fracture healing, and Complications between incomplete group and intact group.
CONCLUSIONS
There is no substantial difference in functional results or complication rates for intertrochanteric fractures with lateral wall fractures, except from increased blood loss and operation time. We believe that an intramedullary nail will be sufficient to repair an intertrochanteric fracture with or without a lateral wall fracture.
背景
对于外侧壁存在的股骨转子间骨折，应用髓内钉-股骨近端防旋髓内钉（PFNA）治疗目前尚无共识。本研究旨在比较 PFNA 手术后外侧壁骨折与非外侧壁骨折的功能结果。
方法
本回顾性研究纳入了 2015 年 1 月至 2018 年 6 月间接受 PFNA 治疗的存在或不存在外侧壁骨折的患者。比较两组患者的手术时间、术中出血量、骨折愈合时间、并发症和功能结果（Harris 髋关节评分和 Parker-Palmer 活动度评分）。
结果
两组患者的年龄、性别分布、损伤机制、骨折类型、体重指数（BMI）、手术时间、美国麻醉医师协会（ASA）评分和复位质量等方面无统计学差异。不完整组的手术时间（54.1±8.74 分钟比 51.0±9.86 分钟）和术中出血量（228.4±48.8 毫升比 151.3±43.5 毫升）均多于对照组（P<0.01）。在功能结果方面，两组患者在术后 3 个月时的 HHS 分别为 76.2±11.6 分和 75.6±12.5 分（P=0.603），术后 6 个月时的 HHS 分别为 81.9±9.4 分和 82.6±8.7 分（P=0.224），术后 12 个月时的 HHS 分别为 83.8±6.6 分和 84.5±6.0 分（P>0.05），术后 24 个月时的 HHS 分别为 85.2±5.5 分和 86.0±5.8 分（P>0.05）；PPMS 的结果相似。不完整组和完整组在负重时间、骨折愈合时间和并发症方面无差异。
结论
除了出血量增加和手术时间延长外，外侧壁存在的股骨转子间骨折与非外侧壁骨折的功能结果或并发症发生率无明显差异。我们认为，髓内钉足以修复存在或不存在外侧壁骨折的股骨转子间骨折。
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