Yang Dongsong, Wang Qiong, Luan Zhonghao, Ling Jiansheng, Chen Peng, Chen Xudong, Yuan Dongtao, Zhen Xiangzhou, Wang Junqiang
Department of Orthopedics, the Second Affiliated Hospital of Luohe Medical College, Luohe Henan, 462300, P. R. China.
Department of Information, the Second Affiliated Hospital of Luohe Medical College, Luohe Henan, 462300, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Oct 15;37(10):1198-1204. doi: 10.7507/1002-1892.202305083.
To evaluate effectiveness of proximal femur bionic nail (PFBN) in treatment of intertrochanteric fractures in the elderly compared to the proximal femoral nail antirotation (PFNA).
A retrospective analysis was made on 48 geriatric patients with intertrochanteric fractures, who met the selection criteria and were admitted between January 2020 and December 2022. Among them, 24 cases were treated with PFBN fixation after fracture reduction (PFBN group), and 24 cases were treated with PFNA fixation (PFNA group). There was no significant difference in baseline data such as age, gender, cause of injury, side and type of fracture, time from injury to operation, and preoperative mobility score, American Society of Anesthesiologists (ASA) score, Alzheimer's disease degree scoring, self-care ability score, osteoporosis degree (T value), and combined medical diseases between the two groups ( >0.05). The operation time, intraoperative blood loss, number of blood transfusions, transfusion volume, length of hospital stay, occurrence of complications, weight-bearing time after operation, and postoperative visual analogue scale (VAS) score, walking ability score, mobility score, self-care ability score were recorded and compared between the two groups. And the radiographic assessment of fracture reduction quality and postoperative stability, and fracture healing time were recorded.
The operations in both groups were successfully completed. All patients were followed up 6-15 months with an average time of 9.8 months in PFBN group and 9.6 months in PFNA group. The operation time was significantly longer in PFBN group than in PFNA group ( <0.05), but there was no significant difference in intraoperative blood loss, number of blood transfusions, transfusion volume, length of hospital stay, change in activity ability score, and change in self-care ability score between the two groups ( >0.05). The weight-bearing time after operation was significantly shorter in PFBN group than in PFNA group ( <0.05), and the postoperative VAS score and walking ability score were significantly better in PFBN group than in PFNA group ( <0.05). Radiographic assessment showed no significant difference in fracture reduction scores and postoperative stability scores between the two groups ( >0.05). All fractures healed and there was no significant difference in fracture healing time between the two groups ( >0.05). The incidence of complications was significantly lower in PFBN group (16.7%, 4/24) than in PFNA group (45.8%, 11/24) ( <0.05).
Compared with PFNA, PFBN in the treatment of elderly intertrochanteric fractures can effectively relieve postoperative pain, shorten bed time, reduce the risk of complications, and facilitate the recovery of patients' hip joint function and walking ability.
比较股骨近端仿生钉（PFBN）与股骨近端抗旋髓内钉（PFNA）治疗老年股骨转子间骨折的疗效。
回顾性分析2020年1月至2022年12月期间收治的48例符合入选标准的老年股骨转子间骨折患者。其中，24例骨折复位后采用PFBN固定（PFBN组），24例采用PFNA固定（PFNA组）。两组患者在年龄、性别、受伤原因、骨折侧别及类型、受伤至手术时间、术前活动能力评分、美国麻醉医师协会（ASA）评分、阿尔茨海默病程度评分、自理能力评分、骨质疏松程度（T值）及合并内科疾病等基线资料方面比较，差异无统计学意义（>0.05）。记录并比较两组患者的手术时间、术中出血量、输血量、输血次数、住院时间、并发症发生情况、术后负重时间以及术后视觉模拟评分（VAS）、行走能力评分、活动能力评分、自理能力评分。同时记录骨折复位质量及术后稳定性的影像学评估结果以及骨折愈合时间。
两组手术均顺利完成。所有患者均获随访6～15个月，PFBN组平均随访时间9.8个月，PFNA组平均随访时间9.6个月。PFBN组手术时间显著长于PFNA组（<0.05），但两组术中出血量、输血量、输血次数、住院时间、活动能力评分变化及自理能力评分变化比较，差异无统计学意义（>0.05）。PFBN组术后负重时间显著短于PFNA组（<0.05），PFBN组术后VAS评分及行走能力评分显著优于PFNA组（<0.05）。影像学评估显示两组骨折复位评分及术后稳定性评分比较，差异无统计学意义（>0.05）。所有骨折均愈合，两组骨折愈合时间比较，差异无统计学意义（>0.05）。PFBN组并发症发生率显著低于PFNA组（16.7%，4/24比45.8%，11/24）（<0.05）。
与PFNA相比，PFBN治疗老年股骨转子间骨折能有效缓解术后疼痛，缩短卧床时间，降低并发症风险，有利于患者髋关节功能及行走能力的恢复。
