InterTan与可膨胀性髓内钉治疗股骨粗隆间骨折的疗效分析

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英文篇名：Effects of InterTan and expandable intramedullary nail on the treatment of intertrochanteric fracture 作者：程建岗 ; 孟国林 ; 袁志 ; 李征宇 ; 宋晨 ; 高嘉锴 英文作者：CHENG Jian-gang;MENG Guo-lin;YUAN Zhi;LI Zheng-yu;SONG Chen;GAO Jia-kai;Xijing Orthopaedic Hospital, Military Medical University of the Air Force; 关键词：股骨骨折 ; 骨折固定术 ; 内 ; 骨折固定术 ; 髓内 ; 老年人 英文关键词：Femoral fractures;;Fracture fixation,internal;;Fracture fixation,intramedullary;;Aged 中文刊名：GZGL 英文刊名：Chinese Journal of Bone and Joint 机构：空军军医大学西京骨科医院;西安市中心医院骨科; 出版日期：2019-06-19 出版单位：中国骨与关节杂志 年：2019 期：v.8 语种：中文; 页：GZGL201906020 页数：4 CN：06 ISSN：10-1022/R 分类号：81-84

摘要

目的对比分析InterTan与股骨近端可膨胀性髓内钉内固定治疗股骨粗隆间骨折的临床疗效。方法选取2014年1月至2016年1月我院收治的老年股骨粗隆间骨折81例,根据手术方法分为两组,InterTan组(42例),其中男15例,女27例,年龄67～88岁,平均(75.3±5.8)岁,左侧20例,右侧22例,骨折按AO分型(A2型31例,A3型11例);可膨胀髓内钉组39例,其中男14例,女25例,年龄65～87岁,平均(74.6±6.1)岁,左侧21例,右侧18例,骨折按AO分型(A2型30例,A3型9例)。比较InterTan与股骨近端可膨胀性髓内钉两种固定方式在出血量、手术时间、术后下床时间、术后并发症发生率、术后Harris评分差异。结果本组随访时间8～24个月,平均18.5个月。可膨胀髓内钉组术后出现褥疮2例、尿路感染2例、肺部感染4例,InterTan组术后出现1例股骨远端骨折,两组相比,差异有统计学意义(P=0.0300);可膨胀髓内钉组术中出血量、手术时间少于InterTan组(P=0.0310、P=0.0008);可膨胀髓内钉组术后下床时间晚于InterTan组,两组相比,差异有统计学意义(P=0.0006);术后Harris评分,两组相比差异无统计学意义(P=0.4090)。结论 InterTan固定强度高,允许患者早期下床,术后并发症少;股骨近端膨胀髓内钉具有手术时间短、出血量少、创伤小的优势,更适合身体耐受能力差,骨质疏松的患者。
        Objective To retrospectively analyze the clinical effects of InterTan and expandable intramedullary nail on the treatment of intertrochanteric fracture. Methods From January 2014 to January 2016, 81 cases of senile intertrochanteric fractures were treated with InterTan and expandable intramedullary nails. InterTan group: 42 cases (20 on the left, 22 on the right); 15 males and 27 females aged (67-88) years with an average of (75.3 ± 5.8) years;AO, 31 cases of type A2 and 11 cases of type A3. Expandable intramedullary nail group: 39 cases (21 on the left, 18 on the right); 14 males and 25 females aged (65-87) years with an average of (74.6 ± 6.1) years; AO, 30 cases of type A2 and 9 cases of type A3. Comparison was made between InterTan and expandable intramedullary nailing in terms of bleeding volume, operation time, postoperative off-bed time, postoperative complication rate and postoperative Harris score. Results All patients were followed up for 8-24 months, with an average of 18.5 months. There were 2 cases of bedsore, 2 cases of urinary tract infection, 4 cases of pulmonary infection in the expandable intramedullary nail group, while 1 case of distal femur fracture in the InterTan group. Statistically significant differences were observed (P = 0.0300). The amount of intraoperative blood loss and operative time in the expandable nail group were significantly lower than those in the InterTan group (P = 0.0310, P = 0.0008). The postoperative off-bed time of the expandable nail group was later than that of the InterTan group with statistically significant differences (P = 0.0006).There were no significant differences in postoperative Harris score (P = 0.4090). Conclusions InterTan fixation strength is high, allowing early off-bed with fewer postoperative complications. Expandable intramedullary nail has advantages of short operative time, less bleeding and less trauma, and is more suitable for patients with poor tolerance and osteoporosis.

引文

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