Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria.
Medical University of Innsbruck, Innsbruck, Austria.
Arch Orthop Trauma Surg. 2024 Jun;144(6):2603-2608. doi: 10.1007/s00402-024-05349-8. Epub 2024 May 3.
The primary aim of this study was to evaluate the clinical and radiological outcomes after surgical treatment of proximal femoral fractures utilizing the Proximal Femoral Nail Antirotation (PFNA), with the main focus on complications and reoperations. The secondary aim was to compare the outcomes of patients with and without cement augmentation of the cephalomedullary nails.
All patients with an acute proximal femoral fracture consequently treated with a PFNA between January 2011 and Dezember 2018 were evaluated. Clinical and radiological data were assessed for intra- and postoperative complications, including treatment failure. In addition, intra- and postoperative radiographs were used to determine the position of the implant, and any migration, via Tip-Apex-Distance (TAD) and the caput-collum-diaphyseal angle (CCD). The accuracy of the fracture reduction was rated according to Baumgaertners criteria.
Two hundred sixty-four consecutive patients (mean age 78.8 ± 12.0; 73.1% female) were included. The predominant OTA/AO fracture classification was 31A1 (153 cases, 58.0%). The average duration of surgery was 63.1 ± 28.0 min and showed no significant differences between PFNA and PFNA with augmentation. The implant positioning was rated as good in 222 cases (84.1%). Two hundred sixty-three patients (99.6%) showed evidence of healing within the time frame of three months postoperatively, one case of delayed union healed after secondary dynamization. During the observational period, 18 patients (6.8%) required a total of 23 additional surgeries. Overall, a lower reoperation rate was observed following the use of the augmentation option (2/86 patients (2.3%) vs. 16/178 patients (9.0%), p = 0.04). In particular, there were no cases of cut-out or cut-through among patients who underwent augmentation as part of osteosynthesis.
Overall reoperation rate after surgical treatment of proximal femoral fractures utilizing the Proximal Femoral Nail Antirotation (PFNA) was 6.8%, with 23 additional surgeries performed in 18 patients. The usage of the PFNA with augmentation showed equally good implant positioning, excellent healing rates and fewer postoperative complications compared to the PFNA implant alone with a similar overall duration of surgery.
本研究的主要目的是评估使用股骨近端防旋髓内钉（PFNA）治疗股骨近端骨折的临床和影像学结果，重点关注并发症和再次手术。次要目的是比较使用和不使用骨水泥增强髓内钉的患者的结果。
评估了 2011 年 1 月至 2018 年 12 月期间因急性股骨近端骨折而接受 PFNA 治疗的所有患者。评估了术中及术后并发症，包括治疗失败。此外，还通过尖端顶点距离（TAD）和股骨头颈干角（CCD）来评估术中及术后 X 线片以确定植入物的位置和任何迁移。骨折复位的准确性根据 Baumgaertner 标准进行评估。
共纳入 264 例连续患者（平均年龄 78.8±12.0；73.1%为女性）。主要的 OTA/AO 骨折分类为 31A1（153 例，58.0%）。平均手术时间为 63.1±28.0 分钟，PFNA 和增强型 PFNA 之间无显著差异。222 例（84.1%）植入物定位良好。263 例（99.6%）患者在术后 3 个月内有愈合证据，1 例延迟愈合病例在二次动力化后愈合。在观察期间，18 例（6.8%）患者总共需要 23 次额外手术。总体而言，使用增强型的再次手术率较低（86 例患者中有 2 例（2.3%），178 例患者中有 16 例（9.0%），p=0.04）。特别是，在接受增强型骨合成的患者中，没有出现切出或穿透的情况。
使用股骨近端防旋髓内钉（PFNA）治疗股骨近端骨折的总体再次手术率为 6.8%，18 例患者进行了 23 次额外手术。与单独使用 PFNA 植入物相比，使用增强型 PFNA 植入物具有相同良好的植入物定位、出色的愈合率和较少的术后并发症，且手术总时长相似。
