防旋股骨近端髓内钉与第三代Gamma钉治疗老年股骨转子间骨折的对比研究

目的 对防旋股骨近端髓内钉(proximal femoral nail antirotation,PFNA)与第三代Gamma钉(third generation of Gamma nail,TGN)治疗老年股骨转子间骨折的手术创伤、并发症及术后疗效进行比较.方法 将2007年1月-2008年6月收治的股骨转子间骨折患者采用随机数字表法分为PFNA组(55例)和TGN组(52例).术前评估两组患者一般资料差异无统计学意义,具有可比性.分别对两组患者的手术创伤,术中、术后并发症及功能恢复情况进行比较.结果 手术时间:PFNA组为(66.6±15.4)min,TGN组为(73.1±20.8)min(P＞0.05).透视时间:PFNA组为(2.97±1.14)min,TGN组为(3.43±1.18)min(P＜0.05);失血量:PFNA组为(219.5±107.5)ml,TGN组为(269.0±123.9)ml(P＜0.05).术中在PFNA击入过程中其远端发生4例股骨干单侧皮质劈裂,TGN组1例,差异无统计学意义.本组91例患者获得随访,PFNA组46例,TGN组45例,随访时间(17.5±3.69)个月.术后PFNA组有1例再骨折,1例内固定失败;TGN组未见此类并发症.随访中51例恢复到伤前活动水平,PFNA组27例,TGN组24例,两者差异无统计学意义.结论 应用PFNA和TGN治疗股骨转子间骨折,在并发症及术后疗效方面差异无统计学意义,但PFNA具有手术时间短、透视少、出血量少等优点.

Abstract：

Objective To compare the outcome of proximal femoral nail antirotation (PFNA)and third generation of Gamma nail (TGN) in the treatment of femoral intertrochanteric fracture in the elderly. Methods From January 2007 to June 2008, the patients with intertrochanteric fractures were divided into PFNA group ( n = 55 ) and TGN group ( n = 52 ) randomly. The two treatment groups were comparable in aspect of general data. The clinical data of surgical trauma, complications and postoperative function of the two groups were compared in our study. Results The mean operation time was (66.6 ± 15.4) min in PFNA group and (73. 1 ± 20.8 ) min in TGN group (P ＞ 0. 05 ). The mean intraoperative blood loss differed significantly, (219.5 ± 107.5 ) ml in PFNA group compared with (269.0 ±123.9) ml in TGN group ( P ＜ 0. 05 ). The mean fluoroscopy time was ( 2.97 ± 1.14 ) min in PFNA group and (3.43 ± 1.18) min in TGN group (P＜0.05). Unilateral femoral shaft splits at the distal end of the nail was observed intra-operatively in four patients of the PFNA group and in one of the TGN group,with no statistical difference between two groups. Of all, 91 patients ( n =46 in the PFNA group and n =45 in the TGN group) were followed up for a duration of ( 17.5 ±3.69) months. There was one re-fracture and one implant failure during the follow up period in PFNA group, which was not found in TGN group. Fiftyone patients recovered to normal activity status, including 27 in the PFNA group and 24 in the TGN group,with no statistical differences. Conclusions Intertrochanteric fracture can be treated successfully with PFNA and TGN. There is no significant difference in complications and functional outcome between the two groups. However, PFNA takes advantages of less blood loss, less operative time and less fluoroscopy time over TGN.

A comparative study on proximal femoral nail antirotation and third generation of Gamma nail treating elder femoral intertrochanteric fracture in the elderly

Objective To compare the outcome of proximal femoral nail antirotation (PFNA)and third generation of Gamma nail (TGN) in the treatment of femoral intertrochanteric fracture in the elderly. Methods From January 2007 to June 2008, the patients with intertrochanteric fractures were divided into PFNA group ( n = 55 ) and TGN group ( n = 52 ) randomly. The two treatment groups were comparable in aspect of general data. The clinical data of surgical trauma, complications and postoperative function of the two groups were compared in our study. Results The mean operation time was (66.6 ± 15.4) min in PFNA group and (73. 1 ± 20.8 ) min in TGN group (P ＞ 0. 05 ). The mean intraoperative blood loss differed significantly, (219.5 ± 107.5 ) ml in PFNA group compared with (269.0 ±123.9) ml in TGN group ( P ＜ 0. 05 ). The mean fluoroscopy time was ( 2.97 ± 1.14 ) min in PFNA group and (3.43 ± 1.18) min in TGN group (P＜0.05). Unilateral femoral shaft splits at the distal end of the nail was observed intra-operatively in four patients of the PFNA group and in one of the TGN group,with no statistical difference between two groups. Of all, 91 patients ( n =46 in the PFNA group and n =45 in the TGN group) were followed up for a duration of ( 17.5 ±3.69) months. There was one re-fracture and one implant failure during the follow up period in PFNA group, which was not found in TGN group. Fiftyone patients recovered to normal activity status, including 27 in the PFNA group and 24 in the TGN group,with no statistical differences. Conclusions Intertrochanteric fracture can be treated successfully with PFNA and TGN. There is no significant difference in complications and functional outcome between the two groups. However, PFNA takes advantages of less blood loss, less operative time and less fluoroscopy time over TGN.