Inter Tan系统与PFNA-Ⅱ系统内固定治疗老年不稳定型股骨粗隆间骨折效果比较
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摘要
目的比较Inter Tan系统与PFNA-Ⅱ系统内固定治疗老年不稳定型股骨粗隆间骨折的效果及安全性。方法选择2009年8月—2014年10月石家庄市第一医院收治的应用Inter Tan系统或PFNA-Ⅱ系统内固定治疗的老年不稳定型股骨粗隆间骨折131例,将采用Inter Tan系统内固定治疗的58例作为Inter Tan组,采用PFNA-Ⅱ系统内固定治疗的73例作为PFNA-Ⅱ组。观察比较两组手术情况及随访情况,并对两组安全性进行评价。结果 Inter Tan组手术时间、X线透视时间及骨折愈合时间均长于PFNA-Ⅱ组,两组比较差异均有统计学意义(P<0.05)。术后各随访时间点髋关节功能Harris评分两组比较差异均无统计学意义(P>0.05)。Inter Tan组术中出现4例医源性股骨近端外侧壁骨折,而PFNA-Ⅱ组术中仅出现1例。PFNA-Ⅱ组3例因植入困难术中更换成短、细主钉,Inter Tan组无植入困难病例。结论老年不稳定型股骨粗隆间骨折应用Inter Tan系统与PFNA-Ⅱ系统内固定治疗均可取得良好效果,但PFNA-Ⅱ系统内固定治疗手术时间、X线透视时间、骨折愈合时间短,且并发症少,能够早期进行功能锻炼。
Objective To compare curative effect and safety between Inter Tan and PFNA-Ⅱ system internal fixation in treatment of elderly patients with unstable fracture of femurs haft. Methods A total of 131 elderly patients with unstable fracture of femurs haft admitted during August 2009 and October 2014 were divided into Inter Tan group( n = 58,treated with Inter Tan system internal fixation) and PFNA-Ⅱ group( n = 73,treated with PFNA-Ⅱ system internal fixation). In two groups,surgical conditions and follow-up data were compared,and conditions of surgical safety were evaluated. Results Surgical time,fluoroscopy time and fracture healed time were significantly longer in Inter Tan group than those in PFNA-Ⅱ group( P < 0. 05). The differences in Harris scores for hip joint function at different times of follow-up were not statistically significant( P > 0. 05). In Inter Tan group,4 patients had iatrogenic lateral proximal fractures during operation during surgery,while 1 patient had iatrogenic lateral proximal fractures during operation in PFNA-Ⅱ group. In PFNA-Ⅱ group,3 patients were required a shorter and smaller nail during surgery because of the implantation difficulty,while none implantation difficulty was found in Inter Tan group. Conclusion Both Inter Tan and PFNA-Ⅱ system internal fixation in treatment of elderly patients with unstable fracture of femurs haft can achieve good effect. PFNA-Ⅱ system internal fixation can achieve short surgical time,fluoroscopy time and fracture healed time with less incidence of complication,and physical training at early stage.
Objective To compare curative effect and safety between Inter Tan and PFNA-Ⅱ system internal fixation in treatment of elderly patients with unstable fracture of femurs haft. Methods A total of 131 elderly patients with unstable fracture of femurs haft admitted during August 2009 and October 2014 were divided into Inter Tan group( n = 58,treated with Inter Tan system internal fixation) and PFNA-Ⅱ group( n = 73,treated with PFNA-Ⅱ system internal fixation). In two groups,surgical conditions and follow-up data were compared,and conditions of surgical safety were evaluated. Results Surgical time,fluoroscopy time and fracture healed time were significantly longer in Inter Tan group than those in PFNA-Ⅱ group( P < 0. 05). The differences in Harris scores for hip joint function at different times of follow-up were not statistically significant( P > 0. 05). In Inter Tan group,4 patients had iatrogenic lateral proximal fractures during operation during surgery,while 1 patient had iatrogenic lateral proximal fractures during operation in PFNA-Ⅱ group. In PFNA-Ⅱ group,3 patients were required a shorter and smaller nail during surgery because of the implantation difficulty,while none implantation difficulty was found in Inter Tan group. Conclusion Both Inter Tan and PFNA-Ⅱ system internal fixation in treatment of elderly patients with unstable fracture of femurs haft can achieve good effect. PFNA-Ⅱ system internal fixation can achieve short surgical time,fluoroscopy time and fracture healed time with less incidence of complication,and physical training at early stage.
引文
[1]赵洪普,徐秋玉,吕玉明,等.三种内固定方法(PFNA、LPFP、DHS)治疗老年股骨粗隆间骨折的比较[J].中国骨与关节损伤杂志,2012,27(6):500-502.
[2]罗湘平,何顺清,李治安,等.锁定钢板与动力髋螺钉治疗股骨粗隆间骨折的临床对照试验[J].中国骨伤,2011,24(3):242-244.DOI:10.3969/j.issn.1003-0034.2011.03.019.
[3]赵椰枫,王鸥,章恺.国产Gamma钉与Inter Tan钉内固定治疗股骨粗隆间骨折的回顾性研究[J].中国骨与关节损伤杂志,2014,29(2):132-134.
[4]张世民,祝晓忠,黄轶刚,等.外侧壁危险型股骨粗隆间骨折DHS与PFNA治疗的回顾性对比研究[J].中国矫形外科杂志,2010,18(22):1868-1872.
[5]窦连荣,窦帮,朱玮,等.老年粗隆间骨折中亚洲型PFNA使用导针扩髓与否的疗效比较[J].组织工程与重建外科杂志,2015,11(5):327-330.
[6]Berger Groch J,Rupprecht M,Schoepper S,et al.Fiveyear outcome analysis of intertrochanteric femur fractures:a prospective randomized trial comparing a 2-screw and a single-screw cephalomedullary nail[J].J Orthop Trauma,2016,30(9):483-488.
[7]Endo Y,Aharonoff G B,Zuckerman J D,et al.Gender differences in patients with hip fracture:a greater risk of morbidity and mortality in men[J].J Orthop Trauma,2005,19(1):29-35.
[8]张伟强,祁宝昌,邓鹏飞,等.老年股骨粗隆间骨折治疗的临床进展[J].中国老年学杂志,2015(1):266-268.DOI:10.3969/j.issn.1005-9202.2015.01.135.
[9]杨子来,来秀芬,陈允震,等.高龄股骨粗隆间骨折治疗策略的临床研究[J].中国骨与关节损伤杂志,2013,28(8):764-765.DOI:10.7531/j.issn.1672-9935.2013.08.028.
[10]沈建辉,史峰军,李刚,等.不同手术方法治疗老年股骨粗隆间骨折的疗效比较[J].中国骨与关节损伤杂志,2013,28(4):314-316.DOI:10.7531/j.issn.1672-9935.2013.04.005.
[11]Xu Y Z,Geng D C,Mao H Q,et al.A comparison of the proximal femoral nail antirotation device and dynamic hip screw in the treatment of unstable pertrochanteric fracture[J].J Int Med Res,2010,38(4):1266-1275.
[12]Haidukewych G J.Intertrochanteric fractures:ten tips to improve results[J].J Bone Joint Surg(Am),2009,91(3):712-719.
[13]Zhang S,Zhang K,Jia Y,et al.Inter Tan nail versus proximal femoral nail antirotation-asia in the treatment of unstable trochanteric fractures[J].Orthopedics,2013,36(3):288-294.
[14]何成文.老年患者股骨粗隆间骨折PFNA治疗的疗效观察[J].中华全科医学,2015,13(4):590-591,598.
[15]刘欣伟,赵勇,周大鹏,等.Inter Tan髓内钉治疗股骨粗隆间骨折100例[J].实用医学杂志,2015,31(6):964-965.DOI:10.3969/j.issn.1006-5725.2015.06.032.
[16]王强,董利军,汪正宇,等.股骨近端髓内钉Inter Tan和股骨近端抗旋髓内钉治疗不稳定型股骨转子间骨折的临床回顾研究[J/CD].中华临床医师杂志:电子版,2015,9(1):64-67.DOI:10.3877/cma.j.issn.1674-0785.2015.01.007.
[17]汤欣,刘谟震,于利,等.新一代髓内钉Inter Tan在股骨转子间骨折治疗中的应用[J].中华创伤骨科杂志,2010,12(9):814-818.
[2]罗湘平,何顺清,李治安,等.锁定钢板与动力髋螺钉治疗股骨粗隆间骨折的临床对照试验[J].中国骨伤,2011,24(3):242-244.DOI:10.3969/j.issn.1003-0034.2011.03.019.
[3]赵椰枫,王鸥,章恺.国产Gamma钉与Inter Tan钉内固定治疗股骨粗隆间骨折的回顾性研究[J].中国骨与关节损伤杂志,2014,29(2):132-134.
[4]张世民,祝晓忠,黄轶刚,等.外侧壁危险型股骨粗隆间骨折DHS与PFNA治疗的回顾性对比研究[J].中国矫形外科杂志,2010,18(22):1868-1872.
[5]窦连荣,窦帮,朱玮,等.老年粗隆间骨折中亚洲型PFNA使用导针扩髓与否的疗效比较[J].组织工程与重建外科杂志,2015,11(5):327-330.
[6]Berger Groch J,Rupprecht M,Schoepper S,et al.Fiveyear outcome analysis of intertrochanteric femur fractures:a prospective randomized trial comparing a 2-screw and a single-screw cephalomedullary nail[J].J Orthop Trauma,2016,30(9):483-488.
[7]Endo Y,Aharonoff G B,Zuckerman J D,et al.Gender differences in patients with hip fracture:a greater risk of morbidity and mortality in men[J].J Orthop Trauma,2005,19(1):29-35.
[8]张伟强,祁宝昌,邓鹏飞,等.老年股骨粗隆间骨折治疗的临床进展[J].中国老年学杂志,2015(1):266-268.DOI:10.3969/j.issn.1005-9202.2015.01.135.
[9]杨子来,来秀芬,陈允震,等.高龄股骨粗隆间骨折治疗策略的临床研究[J].中国骨与关节损伤杂志,2013,28(8):764-765.DOI:10.7531/j.issn.1672-9935.2013.08.028.
[10]沈建辉,史峰军,李刚,等.不同手术方法治疗老年股骨粗隆间骨折的疗效比较[J].中国骨与关节损伤杂志,2013,28(4):314-316.DOI:10.7531/j.issn.1672-9935.2013.04.005.
[11]Xu Y Z,Geng D C,Mao H Q,et al.A comparison of the proximal femoral nail antirotation device and dynamic hip screw in the treatment of unstable pertrochanteric fracture[J].J Int Med Res,2010,38(4):1266-1275.
[12]Haidukewych G J.Intertrochanteric fractures:ten tips to improve results[J].J Bone Joint Surg(Am),2009,91(3):712-719.
[13]Zhang S,Zhang K,Jia Y,et al.Inter Tan nail versus proximal femoral nail antirotation-asia in the treatment of unstable trochanteric fractures[J].Orthopedics,2013,36(3):288-294.
[14]何成文.老年患者股骨粗隆间骨折PFNA治疗的疗效观察[J].中华全科医学,2015,13(4):590-591,598.
[15]刘欣伟,赵勇,周大鹏,等.Inter Tan髓内钉治疗股骨粗隆间骨折100例[J].实用医学杂志,2015,31(6):964-965.DOI:10.3969/j.issn.1006-5725.2015.06.032.
[16]王强,董利军,汪正宇,等.股骨近端髓内钉Inter Tan和股骨近端抗旋髓内钉治疗不稳定型股骨转子间骨折的临床回顾研究[J/CD].中华临床医师杂志:电子版,2015,9(1):64-67.DOI:10.3877/cma.j.issn.1674-0785.2015.01.007.
[17]汤欣,刘谟震,于利,等.新一代髓内钉Inter Tan在股骨转子间骨折治疗中的应用[J].中华创伤骨科杂志,2010,12(9):814-818.