股骨近端防旋髓内钉-Ⅱ治疗老年股骨转子间骨折对患者Harris评分、功能恢复及预后的影响分析
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摘要
目的研究股骨近端防旋髓内钉-Ⅱ治疗老年股骨转子间骨折对患者Harris评分、功能恢复影响,并对预后进行分析。方法老年股骨转子间骨折患者120例,根据手术方法分为动力髋螺钉(DHS)组、股骨近端锁定钢板(LPFP)组和PFNA-Ⅱ组,每组40例。观察3组患者术后不同Evans分型Harris评分、下地负重时间、住院时间、骨折愈合时间,观察3组患者30 d、1年死亡情况。结果 3组术后Ⅰa型Harris评分比较差异无统计学意义(P>0.05)。PFNA-Ⅱ组Ⅰb、Ⅰc、Ⅰd型Harris评分均高于DHS组和LPFP组(P<0.05)。LPFP组Ⅰc、Ⅰd型Harris评分均高于DHS组(P<0.05)。DHS组和LPFP组Ⅰa、Ⅰb、Ⅰc、Ⅰd型Harris评分,组内两两比较差异均有统计学意义(P<0.05)。PFNA-Ⅱ组Ⅰd型Harris评分高于Ⅰb、Ⅰc、Ⅰd型(P<0.05)。PFNA-Ⅱ组Ⅰa、Ⅰb、Ⅰc、Ⅰd型下地负重时间、住院时间均少于DHS组和LPFP组,差异有统计学意义(P<0.05)。PFNA-Ⅱ组Ⅰc型骨折愈合时间少于DHS组,Ⅰd型骨折愈合时间少于DHS组和LPFP组(P<0.05)。DHS组Ⅰd型下地负重时间、住院时间、骨折愈合时间均高于Ⅰa、Ⅰb组(P<0.05)。LPFP组Ⅰd型住院时间高于Ⅰa、Ⅰb组(P<0.05)。PFNA-Ⅱ组Ⅰc、Ⅰd型下地负重时间高于Ⅰa型,Ⅰd型高于Ⅰc型(P<0.05)。PFNA-Ⅱ组Ⅰa、Ⅰb、Ⅰc、Ⅰd型住院时间两两比较(P<0.05)。PFNA-Ⅱ组30 d、1年病死率均低于DHS组和LPFP组(P<0.05)。结论股骨近端防旋髓内钉-Ⅱ治疗不同类型老年股骨转子间骨折可以显著改善髋关节功能,减少患者下地负重时间、住院时间和骨折愈合时间,降低患者病死率。
Objective To investigate the effects of proximal femoral anti-rotation intramedullary nailing on Harris score,functional recovery and prognosis of elderly patients with femoral intertrochanteric fracture. Methods A total of 120 elderly patients with femoral intertrochanteric fracture were divided into three groups according to the surgical methods: dynamic hip screw( DHS) group( n = 40),proximal femoral locking plate( LPFP) group( n = 40) and PFNAⅡ group( n = 40). Harris scores,weight bearing time,length of hospital stay and fracture healing time were observed and compared between two groups.Moreover,the mortality of patients at 30 d,1 year after treatment was observed. Results There were no significant differences in Harris scores of typeⅠa among the three groups( P > 0. 05). The Harris scores of typeⅠb,Ⅰc and typeⅠd in PFNAⅡgroup were significantly higher than those in DHS group and LPFP group( P < 0. 05). The Harris scores of typeⅠc and typeⅠd in LPFP group were significantly higher than those in DHS group( P < 0. 05). There were significant differences in Harris scores ofⅠa,Ⅰb,Ⅰc andⅠd between DHS group and LPFP group( P < 0. 05). The Harris scores of typeⅠd in PFNAⅡ group were significantly higher than those of typeⅠb,typeⅠc and typeⅠd( P < 0. 05). The load bearing time and length of hospital stay of typeⅠa,Ⅰb,Ⅰc andⅠd in PFNAⅡgroup were significantly shorter than those in DHS group and LPFP group( P < 0. 05). The fracture healing time of typeⅠc in PFNAⅡ group was significantly shorter than that in DHS group,and the fracture healing time of typeⅠd was significantly shorter than that in DHS group and LPFP group( P < 0. 05). The load bearing time,length of hospital stay and fracture healing time of type Ⅰd in DHS group were significantly higher than those in type Ia and type Ib( P < 0. 05). The hospital stay of typeⅠd in LPFP group was significantly higher than that in typeⅠa and type Ib( P < 0. 05). The load bearing time of typeⅠc and typeⅠd in PFNAⅡ group were significantly higher than those of typeⅠa,and that of typeⅠd was significantly higher than that of typeⅠc( P < 0. 05). There were significant differences in the length of hospital stay of PFNAⅡ group among typeⅠa,typeⅠb,typeⅠc and typeⅠd each other( P < 0. 05). In addition,the mortality rates at 30 d and a year after treatment in PFNAⅡ group were significantly lower than those in DHS group and LPFP group( P < 0. 05). Conclusion The proximal femoral anti-rotation intramedullary nailing is highly effective in treating femoral intertrochanteric fracture in elderly patients,which can not only significantly improve the function of hip joint,decrease load bearing time,length of hospital stay and fracture healing time,but also reduce the mortality rate of patients.
Objective To investigate the effects of proximal femoral anti-rotation intramedullary nailing on Harris score,functional recovery and prognosis of elderly patients with femoral intertrochanteric fracture. Methods A total of 120 elderly patients with femoral intertrochanteric fracture were divided into three groups according to the surgical methods: dynamic hip screw( DHS) group( n = 40),proximal femoral locking plate( LPFP) group( n = 40) and PFNAⅡ group( n = 40). Harris scores,weight bearing time,length of hospital stay and fracture healing time were observed and compared between two groups.Moreover,the mortality of patients at 30 d,1 year after treatment was observed. Results There were no significant differences in Harris scores of typeⅠa among the three groups( P > 0. 05). The Harris scores of typeⅠb,Ⅰc and typeⅠd in PFNAⅡgroup were significantly higher than those in DHS group and LPFP group( P < 0. 05). The Harris scores of typeⅠc and typeⅠd in LPFP group were significantly higher than those in DHS group( P < 0. 05). There were significant differences in Harris scores ofⅠa,Ⅰb,Ⅰc andⅠd between DHS group and LPFP group( P < 0. 05). The Harris scores of typeⅠd in PFNAⅡ group were significantly higher than those of typeⅠb,typeⅠc and typeⅠd( P < 0. 05). The load bearing time and length of hospital stay of typeⅠa,Ⅰb,Ⅰc andⅠd in PFNAⅡgroup were significantly shorter than those in DHS group and LPFP group( P < 0. 05). The fracture healing time of typeⅠc in PFNAⅡ group was significantly shorter than that in DHS group,and the fracture healing time of typeⅠd was significantly shorter than that in DHS group and LPFP group( P < 0. 05). The load bearing time,length of hospital stay and fracture healing time of type Ⅰd in DHS group were significantly higher than those in type Ia and type Ib( P < 0. 05). The hospital stay of typeⅠd in LPFP group was significantly higher than that in typeⅠa and type Ib( P < 0. 05). The load bearing time of typeⅠc and typeⅠd in PFNAⅡ group were significantly higher than those of typeⅠa,and that of typeⅠd was significantly higher than that of typeⅠc( P < 0. 05). There were significant differences in the length of hospital stay of PFNAⅡ group among typeⅠa,typeⅠb,typeⅠc and typeⅠd each other( P < 0. 05). In addition,the mortality rates at 30 d and a year after treatment in PFNAⅡ group were significantly lower than those in DHS group and LPFP group( P < 0. 05). Conclusion The proximal femoral anti-rotation intramedullary nailing is highly effective in treating femoral intertrochanteric fracture in elderly patients,which can not only significantly improve the function of hip joint,decrease load bearing time,length of hospital stay and fracture healing time,but also reduce the mortality rate of patients.
引文
1 Neuerburg C,Gosch M,Bocker W,et al.Proximal femoralfracturesin the elderly.Z Gerontol Geriatr,2015,48:647-659.
2 Li S,Sun T,Liu Z.Excess mortality of 1 year in elderlyhipfracturepatients compared with the general population in Beijing,China.Arch Osteoporos,2016,11:35.
3 Fujiwara S.Hip fracture-epidemiology,management and liaison service.Risk factor for hip fracture.Clin Calcium,2015,25:499-504.
4 Muhm M,Walendowski M,Danko T,et al.Factors influencing course of hospitalization in patients withhip fractures:Complications,length of stay and hospital mortality.Z Gerontol Geriatr,2015,48:339-345.
5 才林,艾光禹,孙强.老年骨质疏松机制及股骨转子间骨折治疗的研究进展.中华损伤与修复杂志(电子版),2016,11:469-472.
6 Negrete-Corona J,Alvarado-Soriano JC,Reyes-Santiago LA.Hipfractureas risk factor for mortality in patients over 65 years of age.Case-control study.Acta Ortop Mex,2014,28:352-362.
7 Starcevic S,Suljagic V,Stamenkovic D,et al.In-hospital mortality analysis in patients with proximal femoralfractureoperatively treated byhiparthroplasty procedure.Vojnosanit Pregl,2016,73:251-255.
8 Magnusson KA,Gunnarsson B,Sigurdsson GH,et al.Treatment and outcome of patients withhipfracture.Laeknabladid,2016,102:119-125.
9 Dhamangaonkar AC.Dynamic hip screw blade fixation for intertrochanteric hip fractures.J Orthop Surg,2013,21:132-133.
10 Schwartsmann CR,Jacobus LS,Spinelli Lde F,et al.Dynamichipscrew for the treatment of femoral neckfractures:a prospective study with 96patients.ISRN Orthop,2014,2014:257871.
11 Barwar N,Meena S,Aggarwal SK,et al.Dynamichipscrew with locking side plate:a viable treatment option forintertrochanteric fracture.Chin J Traumatol,2014,17:88-92.
12 Ibrahim S,Meleppuram JJ.A retrospective analysis of surgically-treated complex proximal femur fractures with proximal femoral locking compression plate.Rev Bras Ortop,2017,52:644-650.
13 Singh AK,Narsaria N,Srivastava V.Treatment of unstable trochanteric femur fractures:proximal femur nail versus proximal femur locking compression plate.Am J Orthop(Belle Mead NJ),2017,46:E116-E123.
14 Johnson B,Stevenson J,Chamma R,et al.Short-term follow-up of pertrochanteric fractures treated using the proximal femoral locking plate.J Orthop Trauma,2014,28:283-287.
15 Li M,Wu L,Liu Y,et al.Clinical evaluation of the Asian proximal femur intramedullary nail antirotation system(PFNA-II)for treatment of intertrochanteric fractures.J Orthop Surg Res,2014,9:112.
16 Xie H,Wang Z,Zhang J,et al.Clinical outcome of dynamic hip locking plates and proximal femoral nails anti-rotation-Asia for treating intertrochanteric femur fracture with lateral wall fractures in the elder patients.Oncotarget,2017,8:82700-82704.
17 Luo X,He S,Zeng D,et al.Proximal femoral nail antirotation versus hemiarthroplasty in the treatment of senile intertrochanteric fractures:Case report.Int J Surg Case Rep,2017,38:37-42.
18 Jonnes C,Sm S,Najimudeen S.TypeⅡlntertrochanteric fractures:proximal femoral nailing(PFN)versus dynamic hip screw(DHS).Arch Bone Jt Surg,2016,4:23-28.
19 Ma KL,Wang X,Luan FJ,et al.Proximal femoral nails antirotation,Gamma nails,and dynamichipscrews for fixation of intertrochanteric fractures of femur:A meta-analysis.Orthop Traumatol Surg Res,2014,100:859-866.
2 Li S,Sun T,Liu Z.Excess mortality of 1 year in elderlyhipfracturepatients compared with the general population in Beijing,China.Arch Osteoporos,2016,11:35.
3 Fujiwara S.Hip fracture-epidemiology,management and liaison service.Risk factor for hip fracture.Clin Calcium,2015,25:499-504.
4 Muhm M,Walendowski M,Danko T,et al.Factors influencing course of hospitalization in patients withhip fractures:Complications,length of stay and hospital mortality.Z Gerontol Geriatr,2015,48:339-345.
5 才林,艾光禹,孙强.老年骨质疏松机制及股骨转子间骨折治疗的研究进展.中华损伤与修复杂志(电子版),2016,11:469-472.
6 Negrete-Corona J,Alvarado-Soriano JC,Reyes-Santiago LA.Hipfractureas risk factor for mortality in patients over 65 years of age.Case-control study.Acta Ortop Mex,2014,28:352-362.
7 Starcevic S,Suljagic V,Stamenkovic D,et al.In-hospital mortality analysis in patients with proximal femoralfractureoperatively treated byhiparthroplasty procedure.Vojnosanit Pregl,2016,73:251-255.
8 Magnusson KA,Gunnarsson B,Sigurdsson GH,et al.Treatment and outcome of patients withhipfracture.Laeknabladid,2016,102:119-125.
9 Dhamangaonkar AC.Dynamic hip screw blade fixation for intertrochanteric hip fractures.J Orthop Surg,2013,21:132-133.
10 Schwartsmann CR,Jacobus LS,Spinelli Lde F,et al.Dynamichipscrew for the treatment of femoral neckfractures:a prospective study with 96patients.ISRN Orthop,2014,2014:257871.
11 Barwar N,Meena S,Aggarwal SK,et al.Dynamichipscrew with locking side plate:a viable treatment option forintertrochanteric fracture.Chin J Traumatol,2014,17:88-92.
12 Ibrahim S,Meleppuram JJ.A retrospective analysis of surgically-treated complex proximal femur fractures with proximal femoral locking compression plate.Rev Bras Ortop,2017,52:644-650.
13 Singh AK,Narsaria N,Srivastava V.Treatment of unstable trochanteric femur fractures:proximal femur nail versus proximal femur locking compression plate.Am J Orthop(Belle Mead NJ),2017,46:E116-E123.
14 Johnson B,Stevenson J,Chamma R,et al.Short-term follow-up of pertrochanteric fractures treated using the proximal femoral locking plate.J Orthop Trauma,2014,28:283-287.
15 Li M,Wu L,Liu Y,et al.Clinical evaluation of the Asian proximal femur intramedullary nail antirotation system(PFNA-II)for treatment of intertrochanteric fractures.J Orthop Surg Res,2014,9:112.
16 Xie H,Wang Z,Zhang J,et al.Clinical outcome of dynamic hip locking plates and proximal femoral nails anti-rotation-Asia for treating intertrochanteric femur fracture with lateral wall fractures in the elder patients.Oncotarget,2017,8:82700-82704.
17 Luo X,He S,Zeng D,et al.Proximal femoral nail antirotation versus hemiarthroplasty in the treatment of senile intertrochanteric fractures:Case report.Int J Surg Case Rep,2017,38:37-42.
18 Jonnes C,Sm S,Najimudeen S.TypeⅡlntertrochanteric fractures:proximal femoral nailing(PFN)versus dynamic hip screw(DHS).Arch Bone Jt Surg,2016,4:23-28.
19 Ma KL,Wang X,Luan FJ,et al.Proximal femoral nails antirotation,Gamma nails,and dynamichipscrews for fixation of intertrochanteric fractures of femur:A meta-analysis.Orthop Traumatol Surg Res,2014,100:859-866.