防旋型股骨近端髓内钉治疗不稳定股骨转子间骨折的疗效观察

目的探讨应用防旋型股骨近端髓内钉(proximal femoral nail antirotation,PFNA)治疗不同类型不稳定转子间骨折的疗效的区别,并分析原因。方法回顾性分析2015年8月至2017年8月本院收治的行PFNA内固定治疗的不稳定股骨转子间骨折患者142例。骨折按复位后股骨近端内外侧壁的完整性分组:A组,外侧壁损伤组;B组,内侧壁损伤组;C组,同时伴发内外侧壁损伤组;D组,内外侧壁支撑稳定组(对照组)。统计分析各组患者内固定失败率、骨折愈合率、1年内全因死亡率及髋关节功能评分等指标差异。结果最终142例患者得到随访(A组27人,B组43人,C组21人,D组51人),平均随访时间(16.3±3.7)个月。C组内固定失败病例数(5例)高于D组(1例),差异具有统计学意义(P=0.012),其余组间差异无统计学意义;C组骨折不愈合病例数(7例)高于D组(2例),且差异有统计学意义(P=0.001),其余组间差异无统计学意义;C组术后1年内死亡病例数(6例)高于D组(1例),差异具有统计学意义(P=0.002),其余组间差异无统计学意义;髋关节Harris功能评分A组(82.84±4.89)分,B组(77.55±5.74)分,C组(74.23±6.35)分及D组(90.06±4.46)分,B组与C组均差异无统计学意义(P_(bc)=0.286),其余组间差异均有统计学意义(P0.05)。结论PFNA治疗不同类型股骨转子间骨折的疗效有差异。外侧壁损伤及内侧壁损伤均可对转子间骨折愈合及术后髋关节功能恢复产生影响。同时合并外侧壁损伤及内侧壁损伤的患者疗效可能较差,经复位后内外侧壁支撑稳定的患者疗效普遍较好。

Therapeutic effect of PFNA on unstable intertrochanteric fracture of femur

Objective To investigate the difference in the efficacy of proximal femoral nail antirotation (PFNA) in the treatment of different types of unstable intertrochanteric fractures, and try to analyze the causes. Methods A retrospective analysis was made of unstable intertrochanteric fracture of femur who were treated with PFNA internal fixation from August 2015 to August 2017 in our hospital. Fractures were grouped according to the integrity of the proximal and lateral femoral walls after reduction: group A, lateral wall injury group; group B, medial wall injury group; group C, concomitantly with medial and lateral wall injury group; group D, medial and lateral wall support stability group (control group). The failure rate of internal fixation fracture healing rate, all-cause mortality rate within one year and hip function score were compared among the groups with the way of Chi-square test and variance analysis. Results Finally, 142 patients were followed up (27 cases in group A, 43 cases in group B, 21 cases in group C and 51 cases in group D), with an average follow-up time of (16.3±3.7) months. The failure case of internal fixation in group C (5 cases) was higher than that in group D (1 case) (P=0.012), and there was no significant difference between other groups. The nonunion case of fracture in group C (7 cases) was higher than that in group D (2 cases) (P =0.001), and there was no significant difference between other groups. The case of death within one year after operation in group C (6 cases) was higher than that in group D (1 case) (P =0.002), and there was no significant difference between other groups.The Harris score of hip joint was (82.84±4.89) in group A, (77.55±5.74) in group B, (74.23±6.35) in group C and (90.06±4.46) in group D. There was no significant difference between group B and group C (Pbc=0.286), and there was significant difference between other groups (P<0.05). Conclusion PFNA has different therapeutic effects on different types of intertrochanteric fracture of femur. Both lateral wall injury and medial wall injury have influence on healing rate of fracture and functional recovery of hip joint after PFNA internal fixation.