LISS钢板倒置与PFNA治疗老年股骨近端骨折合并髋内翻畸形的疗效对比

目的比较倒置股骨远端微创内固定系统（LISS）与股骨近端防旋髓内钉（PFNA）治疗老年股骨近端骨折合并髋关节内翻畸形的临床疗效。方法回顾性分析2009年1月至2012年12月采用PFNA和倒置LISS钢板内固定治疗的且随访时间均超过10个月的45例老年股骨近端骨折合并髋关节内翻畸形患者的病例资料,其中采用LISS倒置钢板治疗者22例（LISS组）,采用PFNA内固定治疗者23例（PFNA组）,两组患者术前一般资料比较差异均无统计学意义（P〉0.05）,具有可比性。比较两组患者的术前美国麻醉学会（American Society of Anesthesiologists,ASA）评分、手术时间、术中出血量、骨折复位质量、住院时间、术后负重时间、骨折愈合时间、颈干角丢失情况、术后并发症发生情况以及术后8个月髋关节Harris评分等。结果所有患者获得10～13个月的随访,平均11.8个月。两组术前ASA评分、手术时间、术中出血、骨折复位质量、住院时间、术后8个月髋关节Harris评分及术后并发症方面比较差异均无统计学意义（P〉0.05）;LISS组钢板倒置完全负重时间和骨折愈合时间较PFNA组延长分别为（16.8±3.5）周、（30.4±11.9）周vs（9.7±1.9）周、（18.3±7.4）周;P值均〈0.05],两组术前及术后颈干角差异无统计学意义,随访10个月后,LISS组和PFNA组颈干角差异有统计学意义（125.1±7.1）°vs（121.3±7.4）°,P〈0.05]。结论 PFNA可允许老年股骨近端骨折合并髋关节内翻畸形早期负重,但对于骨质疏松严重、内固定切割风险较高的患者,LISS钢板倒置可降低术后髋内翻的发生率。

Comparison of reverse LISS and PFNA in the treatment of elderly proximal femur fractures complicated with coxa vam

Objective To compare the clinical effects of proximal femoral nail antirotation blade（PFNA）with reverse less invasive stabilization system（LISS） in the treatment of proximal femur fractures complicated with coxa vam.Methods From Jan 2009 to Dec 2012, 45 patients with proximal femur fractures complicated with coxa vam were treated with reverse LISS（22 patients） and PFNA（23 patients）. There were no significant differences in the general data of the patients between the two groups（P〉0.05）. The physical status of patients was evaluated according to the American Society of Anesthesiologists（ASA） score. After the operation, the operation duration and volume of blood loss, full weight bearing time, fracture healing time, and neck-shaft angle discrepancy related to contralateral side were assessed in the two groups, respectively. Functional recovery was evaluated according to Harris score and complication. Results The patients were followed up for 10 to 13 months（13.8 months in average）. There was no significant differences between the two groups in operation time, perioperative blood, hospital stay, quality reduction, time of bone union, and postoperative complications or Harris score at 8 months postoperation（P〉0.05）. The time for full weight bearing and fracture healing in the two groups were（16.8±3.5） weeks vs（9.7±1.9） weeks, and（30.4±11.9） weeks vs（18.3 ± 7.4） weeks respectively, with no significant differences（P〈0.05）. There was no significant difference in Neck-shaft angle between LISS group and PFNA group before and after surgery, but at 10 months after surgery, a significant difference appeared （125.1±7.1）° vs（121.3±7.4）°, P〈0.05]. Conclusion The results of PFNA and reverse LISS in the treatment of proximal femur fracture are satisfactory. The fracture treated by PFNA allowed earlier weight bearing. Reverse LISS could avoid coxa vam effectively.