老年骨质疏松性股骨粗隆间骨折的内固定器选择

目的 探讨不同类型老年骨质疏松性股骨粗隆间骨折的内固定器选择.方法 回顾性分析我院于2013年6月至2015年6月收治的252例老年骨质疏松性股骨粗隆间骨折病人的临床资料.病人均采取闭合复位内固定手术,根据内固定器不同分为股骨近端防旋髓内钉(proximal femoral nail antiro-tation,PFNA)-Ⅱ组(154例)和InterTan组(98例).对比分析两组病人的骨折类型情况、术中情况、术后骨折愈合、患髋功能恢复情况和并发症等.结果 病人均顺利完成手术及随访.PFNA-Ⅱ组病人手术时间为(44.17±6.75)min、术中出血量为(140.34±15.68)ml,均显著少于InterTan组的(60.32±7.39)min和(178.26±18.25)ml(均P=0.000).术后PFNA-Ⅱ组病人股骨干骨折率显著高于InterTan组(P=0.032),股骨颈缩短长度多于InterTan组(P=0.000),髋关节或大腿疼痛发生率(15.58%)显著高于InterTan组(5.10%)(P=0.011).两组病人骨折愈合时间、远端钉尖位置、Harris髋关节评分及其他并发症比较,差异均无统计学意义(均P>0.05).结论 PFNA-Ⅱ操作相对简单,但InterTan钉疗效更好,对于简单的骨质疏松性股骨粗隆间骨折可选择PFNA-Ⅱ或InterTan钉;对于Evans-JensenⅡB或Ⅲ型等稳定性较差的复杂骨折,选择InterTan钉更有优势;老年病人如果基础情况较差,且需尽快完成手术,选择PFNA-Ⅱ钉可缩短手术时间.

Selection of internal fixations for different types of osteoporotic intertrochanteric femur fractures in the elderly

Objective To explore the selection of internal fixations for different types of osteoporotic intertrochanteric femur fractures in the elderly. Methods The clinical data of 252 elderly patients with osteoporotic intertrochanteric fractures treated in our hospital from June 2013 to June 2015 were analyzed retrospectively. All patients were treated with closed reduction and internal fixation with proximal femoral nail antirotation (PFNA)-Ⅱor InterTan intramedullary nail. Intraoperative variables, fracture healing time, recovery of hip function and postoperative complications were compared between the two groups. Results All patients were subjected successfully to the surgery and followed up. The operative time was shorter and bleeding volume was less in PFNA-Ⅱ group than in InterTan group (P=0.000). The femoral shaft fracture rate (4.55%) of PFNA-Ⅱ group was significantly higher than that of InterTan group (0%) (P=0.032). The femoral neck shortening amplitude of PFNA-Ⅱ group was significantly higher than that of InterTan group (P=0.000). The incidence of hip or thigh pain (15.58%) of PFNA-Ⅱ group was significantly higher than that of InterTan group (5.10%) (P=0.011). The fracture healing time of the two groups showed no significant difference (P=0.180). There was no significant difference between the two groups in the distal tip position, Harris hip score, and other postoperative complications (all P>0.05). Conclusion PFNA-Ⅱ has the advantages of simple operation, but the therapeutic effect of InterTan nail was better. For simple osteoporotic femoral intertrochanteric fractures, we could choose PFNA-Ⅱ or InterTan nail. For complex unstable fractures with Evans-JensenⅡB orⅢtype, InterTan nail has more advantages. For some elderly patients with severe basic diseases who need to complete the operation as soon as possible, PFNA-Ⅱnail could shorten the operation time.