股骨近端防旋髓内钉-Ⅱ治疗老年股骨转子间骨折对影像学指标、WOMAC评分的影响及安全性评价
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摘要
目的研究股骨近端防旋髓内钉-Ⅱ(PFNA-Ⅱ)治疗老年股骨转子间骨折对患者影像学指标、WOMAC评分的影响,并对安全性进行评价。方法老年股骨转子间骨折患者120例,根据随机数字表法分为动力髋螺钉(DHS)组、股骨近端锁定钢板(LPFP)组和PFNA-Ⅱ组,每组40例。观察3组影像学指标(术后、6个月后顶尖距、颈干角,颈干角10°以上变化率)、髋关节WOMAC评分(观察患者治疗后2、4、6个月WOMAC评分)、并发症发生情况。结果 3组术后顶尖距、颈干角比较,差异无统计学意义(P<0.05)。术后6个月PFNA-Ⅱ组顶尖距、颈干角、颈干角10°以上变化率均显著低于DHS组和LPFP组,差异有统计学意义(P<0.05)。DHS组和LPFP组术后6个月顶尖距高于术后,颈干角明显低于术后,差异有统计学意义(P<0.05)。PFNA-Ⅱ组术后6个月顶尖距、颈干角与术后比较,差异无统计学意义(P>0.05)。3组术后2个月髋关节WOMAC评分比较,差异无统计学意义(P>0.05)。PFNA-Ⅱ组术后4、6个月髋关节WOMAC评分均低于DHS组和LPFP组,LPFP组术后6个月低于DHS组,差异均有统计学意义(P<0.05)。3组术后4个月髋关节WOMAC评分均低于术后2个月,高于术后6个月,差异均有统计学意义(P<0.05)。PFNA-Ⅱ组并发症发生率低于DHS组、LPFP组,差异有统计学意义(P<0.05)。结论 PFNA-Ⅱ治疗老年股骨转子间骨折可以增加骨折部位的稳定性,有效降低顶尖距和颈干角的变化,改善髋关节功能,减少并发症发生。
Objective To investigate the effects of proximal femoral interlocking intramedullary nailing-Ⅱ( PFNA-Ⅱ) on imaging parameters and Western Ontario and Mc Master Universities( WOMAC) score in treatment of femoral intertrochanteric fractures in the elderly,and to evaluate its safety. Methods A total of 120 elderly patients with femoral intertrochanteric fractures were divided into dynamic hip screw( DHS) group,proximal femoral locking plate( LPFP) group and proximal femoral interlocking intramedullary nailing Ⅱ( PFNA-Ⅱ) group according to random number table method,with40 patients in each group. The imaging indexes including top distance,neck shaft angle and change rate of neck shaft angle >10°,hip joint WOMAC score of patients at 2 m,4 m,and 6 m after treatment,and incidence of complications were observed and compared among the three groups. Results There were no significant differences in top distance and neck shaft angle among the three groups( P > 0. 05). At 6 months after operation,top the distance,neck shaft angle and change rate of neck shaft angle > 10°in PFNA-Ⅱ group were significantly lower than those in DHS group and LPFP group( P < 0. 05). Moreover the top distance in DHS group and LPFP group at 6 months after operation was significantly higher than that after operation,however neck shaft angle was significantly lower than that after operation( P < 0. 05). There were no significant differences in top distance and neck shaft angle in PFNA-Ⅱ group between 6 months after operation and after operation( P > 0. 05),moreover there were no significant differences in hip joint WOMAC scores at 2 months after operation among the three groups( P > 0. 05). In addition the hip joint WOMAC scores at 4 m and 6 m after operation in PFNA-Ⅱ group were significantly lower than those in DHS and LPFP groups,which in LPFP group at 6 m after operation were significantly lower than those in DHS group( P < 0. 05). The hip joint WOMAC scores at 4 months after operation in the three groups were significantly lower than those at 2 m after operation,which were significantly higher than those at 6 months after operation( P < 0. 05). Finally the incidence rate of complications in PFNA-Ⅱ group was significantly lower than that in DHS group and LPFP group( P <0. 05). Conclusion PFNA-Ⅱ in treatment of femoral intertrochanteric fractures in the elderly can increase stability of fracture site,effectively decrease the changes of top distance and neck shaft angle,improve hip joint function and reduce incidence of complications.
Objective To investigate the effects of proximal femoral interlocking intramedullary nailing-Ⅱ( PFNA-Ⅱ) on imaging parameters and Western Ontario and Mc Master Universities( WOMAC) score in treatment of femoral intertrochanteric fractures in the elderly,and to evaluate its safety. Methods A total of 120 elderly patients with femoral intertrochanteric fractures were divided into dynamic hip screw( DHS) group,proximal femoral locking plate( LPFP) group and proximal femoral interlocking intramedullary nailing Ⅱ( PFNA-Ⅱ) group according to random number table method,with40 patients in each group. The imaging indexes including top distance,neck shaft angle and change rate of neck shaft angle >10°,hip joint WOMAC score of patients at 2 m,4 m,and 6 m after treatment,and incidence of complications were observed and compared among the three groups. Results There were no significant differences in top distance and neck shaft angle among the three groups( P > 0. 05). At 6 months after operation,top the distance,neck shaft angle and change rate of neck shaft angle > 10°in PFNA-Ⅱ group were significantly lower than those in DHS group and LPFP group( P < 0. 05). Moreover the top distance in DHS group and LPFP group at 6 months after operation was significantly higher than that after operation,however neck shaft angle was significantly lower than that after operation( P < 0. 05). There were no significant differences in top distance and neck shaft angle in PFNA-Ⅱ group between 6 months after operation and after operation( P > 0. 05),moreover there were no significant differences in hip joint WOMAC scores at 2 months after operation among the three groups( P > 0. 05). In addition the hip joint WOMAC scores at 4 m and 6 m after operation in PFNA-Ⅱ group were significantly lower than those in DHS and LPFP groups,which in LPFP group at 6 m after operation were significantly lower than those in DHS group( P < 0. 05). The hip joint WOMAC scores at 4 months after operation in the three groups were significantly lower than those at 2 m after operation,which were significantly higher than those at 6 months after operation( P < 0. 05). Finally the incidence rate of complications in PFNA-Ⅱ group was significantly lower than that in DHS group and LPFP group( P <0. 05). Conclusion PFNA-Ⅱ in treatment of femoral intertrochanteric fractures in the elderly can increase stability of fracture site,effectively decrease the changes of top distance and neck shaft angle,improve hip joint function and reduce incidence of complications.
引文
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9 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.
10 Dhamangaonkar AC,Joshi D,Goregaonkar AB,et al.Letter to the editor:Proximal femoral locking plate versus dynamic hip screw for unstable intertrochanteric femoral fractures.J Orthop Surg,2013,21:317-322.
11 Johnson B,Stevenson J,Chamma R,et al.Short-term follow-up of pertrochanteric fractures treated using theproximal femoral locking plate.J Orthop Trauma,2014,28:283-287.
12 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.
13 Jonnes C,Sm S,Najimudeen S.Type IIIntertrochanteric Fractures:Proximal Femoral Nailing(PFN)Versus Dynamic Hip Screw(DHS).Arch Bone Jt Surg,2016,4:23-28.
14 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 Yoon BH1,Lee YK,Kim SC,et al.Epidemiologyof proximal femoralfracturesin South Korea.Arch Osteoporos,2013,8:157.
3 Neuerburg C,Gosch M,B9cker W,et al.Proximal femoralfracturesin the elderly.Z Gerontol Geriatr,2015,48:647-659.
4 Prasad JD,Varghese AK,Jamkhandi D,et al.Quality-of-life among elderly with untreated fracture of neck of femur:a community based study from southern india.J Family Med Prim Care,2013,2:270-273.
5 van de Ree CLP,De Jongh MAC,Peeters CMM,et al.Hip fracturesin elderly people:surgery or no surgery?A systematic review and metaanalysis.Geriatr Orthop Surg Rehabil,2017,8:173-180.
6 Niu E,Yang A,Harris AH,et al.Which fixation device is preferred for surgical treatment of intertrochanteric hip fracturesin the united states?A survey of orthopaedic surgeons.Clin Orthop Relat Res,2015,473:3647-3655.
7 Mears SC.Classification and surgical approaches tohip fracturesfor nonsurgeons.Clin Geriatr Med,2014,30:229-241.
8 Sandmann GH,Biberthaler P.Pertrochanteric femoralfracturesin the elderly.Unfallchirurg,2015,118:447-460.
9 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.
10 Dhamangaonkar AC,Joshi D,Goregaonkar AB,et al.Letter to the editor:Proximal femoral locking plate versus dynamic hip screw for unstable intertrochanteric femoral fractures.J Orthop Surg,2013,21:317-322.
11 Johnson B,Stevenson J,Chamma R,et al.Short-term follow-up of pertrochanteric fractures treated using theproximal femoral locking plate.J Orthop Trauma,2014,28:283-287.
12 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.
13 Jonnes C,Sm S,Najimudeen S.Type IIIntertrochanteric Fractures:Proximal Femoral Nailing(PFN)Versus Dynamic Hip Screw(DHS).Arch Bone Jt Surg,2016,4:23-28.
14 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.