摘要
目的比较股骨近端防旋髓内钉(PFNA)联合外侧重建接骨板与InterTAN髓内钉治疗老年AO/OTA A3.3型股骨粗隆间骨折疗效。方法回顾性分析2018年1月—2023年12月海军第九七一医院骨科收治的行PFNA联合外侧壁重建或InterTAN治疗的81例AO/OTA A3.3型股骨粗隆间骨折患者。其中男性37例,女性44例;年龄60~81岁,平均72.5岁。道路交通伤47例,摔伤34例。按照手术方式不同分为外侧壁重建组(36例)和InterTAN组(45例),外侧壁重建组接受PFNA固定+外侧壁重建,InterTAN组接受InterTAN髓内钉固定。比较两组患者手术时间、术中出血量、下地时间、负重时间、骨折愈合时间、尖顶距(TAD)、术后12个月时Harris髋关节功能评分(HHS)、Parker-Palmer活动能力评分(PPMS)、术后1年内并发症。结果外侧壁重建组手术时间、术中出血量多于InterTAN组,术后下地时间、完全负重时间、骨折愈合时间短于InterTAN组[手术时间(101.7±16.7)min vs.(89.3±12.5)min;术中出血量(123.5±18.2)mL vs.(112.1±21.8)mL;术后下地时间(14.3±1.2)d vs.(18.6±1.3)d;完全负重时间(13.6±3.4)周vs.(15.5±3.5)周;骨折愈合时间(11.8±1.2)周vs.(12.7±1.1)周],术后12个月时HHS高于InterTAN组[(91.6±7.5)分vs.(84.3±8.8)分],PPMS高于InterTAN组[(8.5±1.7)分vs.(7.4±1.7)分],差异有统计学意义(P均<0.05)。两组患者术后2、12个月股骨颈长度均较术后2 d缩短,且外侧壁重建组的股骨颈长度较InterTAN组更短[(43.8±2.1)mm、(42.6±1.9)mm vs.(44.6±1.0)mm、(43.7±0.9)mm,P均<0.05]。结论与单独使用InterTAN固定比较,使用PFNA与外侧壁重建接骨板治疗A3.3型股骨粗隆骨折术后负重锻炼更早、骨折愈合时间更短、髋关节功能恢复更好。
Objective To compare the efficacy of proximal femoral nail antirotation(PFNA)combined with an anterolateral reconstruction plate and the InterTAN intramedullary nailing in the treatment of elderly patients with AO/OTA A3.3 intertrochanteric fractures of the femur.Methods This retrospective analysis was conducted on clinical data of patients with AO/OTA A3.3 intertrochanteric femoral fractures treated with either PFNA combined with lateral wall reconstruction or InterTAN at our department from Jan.2018 to Dec.2023.A total of 81 patients,37 males and 44 females,aged 60-81(mean 72.5)years,were enrolled.The injury causes were road traffic accidents in 47 cases,and falls in 34 cases.According to the treatment they received,patients were divided into lateral wall reconstruction group(36 cases)and InterTAN group(45 cases).In the former,there were 16 males and 20 females of 60-81(mean 73.2)years,who received PFNA fixation with lateral wall reconstruction(17 left side and 19 right).In the latter,there were 21 males and 24 females of 61-78(mean 71.9)years,who received InterTAN intramedullary nail fixation(24 left side and 21 right).Comparisons between the two groups included operation time,intraoperative blood loss,off-bed activity time,full weight-bearing time,fracture healing time,tip-apex distance(TAD),Harris hip score(HHS)and Parker-Palmer mobility score(PPMS)at 12 months postoperatively,and complications within 1 year after surgery.Results The lateral wall reconstruction group exhibited a longer operative time(min,101.7±16.7 vs.89.3±12.5)and more intraoperative blood loss(mL,123.5±18.2 vs.112.1±21.8),compared to the InterTAN group.However,it demonstrated significant advantages in postoperative recovery parameters:earlier off-bed activities(d,14.3±1.2 vs.18.6±1.3)and weight-bearing(week,13.6±3.4 vs.15.5±3.5),faster fracture healing(week,11.8±1.2 vs.12.7±1.1),and higher HHS(91.6±7.5 vs.84.3±8.8)and PPMS(8.5±1.7 vs.7.4±1.7)at 12 months,all revealing statistically significant differences(P<0.05).Both groups showed progressive shortening of femoral neck length at 2 and 12 months postoperatively compared to immediate postoperative measurements(2 d).Notably,the lateral wall reconstruction group demonstrated significantly shorter femoral neck dimensions at both follow-up intervals(mm,43.8±2.1 vs.44.6±1.0 at 2 months;42.6±1.9 vs.43.7±0.9 at 12 months)compared to the InterTAN group(P<0.05).Conclusion Compared with InterTAN fixation alone,the use of PFNA and lateral wall reconstruction plate for the treatment of A3.3 femoral trochanteric fractures results in earlier weight-bearing exercise,quicker fracture healing,and better hip joint functional recovery.
作者
夏国峰
张蓉
刘琪
李晓亮
孙培锋
Xia Guofeng;Zhang Rong;Liu Qi;Li Xiaoliang;Sun Peifeng(Department of Orthopedics,No.971 Hospital of the PLA Navy,Qingdao,Shandong Province 266071,China)
出处
《创伤外科杂志》
2025年第12期921-927,共7页
Journal of Traumatic Surgery
基金
青岛市卫健委医药科研指导计划项目(2023-WJZD245)。
