Singh Gagandeep, Kumar Anoop, Bhat Mohhamad Farooq, Thakur Amit
Orthopedics, All India Institute of Medical Sciences, Vijaypur, Jammu, IND.
Orthopedics, Government Medical College and Hospital, Jammu, IND.
Cureus. 2024 Jul 18;16(7):e64839. doi: 10.7759/cureus.64839. eCollection 2024 Jul.
Introduction Peritrochanteric fractures are defined as extra-articular fractures involving the trochanter and frequent extension into the subtrochanteric region. These fractures exhibit a bimodal distribution in terms of age. These fractures commonly happen in young individuals who experience high-energy trauma, often in combination with other injuries. In contrast, elderly individuals with osteopenia are more prone to fractures caused by low-energy trauma. Methods This study is a prospective investigation that was carried out over 30 months. The study focused on peritrochanteric fractures that were treated using proximal femoral nail antirotation-2 (PFNA-2) as a fixation device. A range of criteria were examined and documented, encompassing the mean duration of surgical procedures, blood loss, the duration of hospitalization, mobility, and any potential post-operative problems. Subsequent assessments were conducted at fixed intervals of two weeks, six weeks, three months, six months, and two years. The functional outcome analysis for all patients involved the utilization of the modified Harris hip score (HHS). Results The study involved 60 cases of peritrochanteric fractures. The average age was 56 years. The most common mode of trauma was trivial fall/slip (46.66%), followed by road traffic accidents (RTA) (31.66%) and falls from height (21.66%). The average operating time was 53.03±5.66 minutes. The average modified Harris hip score was 84.78 with 26.66% excellent, 70% good, and 3.33% fair results. Complications included superficial wound infection (5%), knee stiffness (11.66%), hip pain (8.33%), and shortening (1.66%). Conclusion PFNA-2 is a safe and easy implant option for treating peritrochanteric fractures as it preserves periosteal covering, minimizes blood loss, has a short operative time, and helps in early mobilization. PFNA-2 provides excellent outcomes in patients with peritrochanteric fractures with minimum complication rates compared to all other open methods and is highly recommendable.
引言
转子周围骨折被定义为累及转子的关节外骨折，且常延伸至转子下区域。这些骨折在年龄方面呈现双峰分布。此类骨折常见于遭受高能量创伤的年轻个体，且常合并其他损伤。相比之下，患有骨质减少的老年人更容易因低能量创伤而发生骨折。
方法
本研究是一项为期30个月的前瞻性调查。该研究聚焦于使用股骨近端抗旋髓内钉-2（PFNA-2）作为固定装置治疗的转子周围骨折。检查并记录了一系列标准，包括手术平均时长、失血量、住院时长、活动能力以及任何潜在的术后问题。随后在两周、六周、三个月、六个月和两年的固定间隔时间进行评估。对所有患者的功能结果分析采用改良Harris髋关节评分（HHS）。
结果
该研究纳入了60例转子周围骨折病例。平均年龄为56岁。最常见的创伤方式是轻微跌倒/滑倒（46.66%），其次是道路交通事故（RTA）（31.66%）和高处坠落（21.66%）。平均手术时间为53.03±5.66分钟。平均改良Harris髋关节评分为84.78分，其中优占26.66%，良占70%，尚可占3.33%。并发症包括浅表伤口感染（5%）、膝关节僵硬（11.66%）、髋关节疼痛（8.33%）和肢体短缩（1.66%）。
结论
PFNA-2是治疗转子周围骨折的一种安全且简便的植入物选择，因为它保留了骨膜覆盖，减少了失血量，手术时间短，并有助于早期活动。与所有其他开放手术方法相比，PFNA-2在转子周围骨折患者中能提供极佳的治疗效果，并发症发生率最低，强烈推荐使用。
