Güzel İsmail, Ulusoy İbrahim, Tantekin Mehmet Fırat, Yılmaz Mehmet, Kıvrak Aybars
Department of Orthopedic Surgery, Malatya Turgut Özal Üniversitesi, Malatya, Battalgazi, Turkey.
Department of Orthopedic Surgery, Selahhadin Eyyubi State Hospital, Diyarbakir, Turkey.
Arch Orthop Trauma Surg. 2025 Sep 10;145(1):443. doi: 10.1007/s00402-025-06065-7.
This study aimed to compare the clinical outcomes and cost-effectiveness of two widely used intramedullary fixation systems-the Proximal Femoral Nail Antirotation (PFNA) and the Proximal Femoral Nail with Talon Locking System (PFN-TLS)-in the treatment of intertrochanteric femur fractures (ITFF).
A retrospective cohort study was conducted on 118 patients aged 65-90 years who underwent surgical treatment for ITFF using either PFNA (n = 53) or PFN-TLS (n = 65). All patients were followed for a minimum of 24 months. Preoperative functional evaluation was unavailable; outcomes were assessed at 24 months postoperatively. Surgical parameters, complication and revision rates, functional outcomes (Harris Hip Score [HHS], Visual Analog Scale [VAS], and SF-36), and health-economic indicators (Quality-Adjusted Life Years [QALY], Incremental Cost-Effectiveness Ratio [ICER]) were evaluated. Binary logistic regression analysis was performed to determine independent predictors of favorable functional outcomes.
The PFN-TLS group demonstrated significantly shorter surgical duration, reduced incision length, and lower fluoroscopy exposure (p < 0.05). At the 24-month follow-up, HHS was significantly higher in the PFN-TLS group (82.7 ± 7.4) compared to the PFNA group (76.4 ± 8.1; p = 0.001). VAS and SF-36 scores were also higher, although not statistically significant. Revision rates showed a non-significant trend favoring PFN-TLS. QALY gains were slightly higher in the PFN-TLS group (0.530 vs. 0.449), with a lower cost per QALY ($1,637.93 vs. $1,863.22). PFN-TLS use was independently associated with favorable functional outcomes (OR: 2.62; 95% CI 1.23-5.58; p = 0.013).
Both PFNA and PFN-TLS are effective options for the management of ITFF. However, PFN-TLS may offer additional clinical and economic benefits, including improved functional outcomes and greater cost-efficiency. Findings should be interpreted with caution due to the retrospective design. Prospective, randomized studies are needed to validate these results and guide implant selection in clinical practice.
本研究旨在比较两种广泛使用的髓内固定系统——股骨近端防旋髓内钉（PFNA）和带爪锁定系统的股骨近端髓内钉（PFN-TLS）——治疗股骨转子间骨折（ITFF）的临床疗效和成本效益。
对118例年龄在65 - 90岁接受ITFF手术治疗的患者进行回顾性队列研究，其中53例使用PFNA，65例使用PFN-TLS。所有患者至少随访24个月。术前无法进行功能评估；术后24个月评估结果。评估手术参数、并发症和翻修率、功能结局（Harris髋关节评分[HHS]、视觉模拟评分[VAS]和SF-36）以及健康经济指标（质量调整生命年[QALY]、增量成本效益比[ICER]）。进行二元逻辑回归分析以确定功能结局良好的独立预测因素。
PFN-TLS组手术时间明显更短，切口长度减小，透视暴露更低（p < 0.05）。在24个月随访时，PFN-TLS组的HHS（82.7 ± 7.4）明显高于PFNA组（76.4 ± 8.1；p = 0.001）。VAS和SF-36评分也更高，尽管无统计学意义。翻修率显示出有利于PFN-TLS的非显著趋势。PFN-TLS组的QALY增益略高（0.530对0.449），每QALY成本更低（1637.93美元对1863.22美元）。使用PFN-TLS与良好的功能结局独立相关（OR：2.62；95%CI 1.23 - 5.58；p = 0.013）。
PFNA和PFN-TLS都是治疗ITFF的有效选择。然而，PFN-TLS可能提供额外的临床和经济效益，包括改善功能结局和更高的成本效率。由于研究为回顾性设计，结果应谨慎解读。需要进行前瞻性随机研究以验证这些结果并指导临床实践中的植入物选择。
