有限切开钛缆捆扎辅助PFNA与单纯微创辅助PFNA治疗老年骨质疏松性31-A3型股骨粗隆间骨折的疗效对比
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摘要
目的比较有限切开钛缆捆扎辅助股骨近端髓内钉(proximal femoral nail antirotation,PFNA)与单纯微创辅助PFNA治疗老年骨质疏松性31-A3型股骨粗隆间骨折患者的临床疗效。方法对2014年1月至2017年1月我院收治的46例老年31-A3型股骨粗隆间骨折患者,分别采用钛捆扎辅助PFNA (A组,23例)与骨拨或复位钳等辅助PFNA治疗(B组,23例),对比分析两组的手术时间、术中出血量、术后6个月起立行走情况,术后并发症发生率,两组骨折愈合时间及术后髋关节功能评分情况。结果两组获平均25.4(12～32)个月随访,切口均一期愈合,无感染、血管神经损伤,无下肢深静脉血栓形成、脂肪栓塞。两组骨折愈合时间(A组平均7.5个月,B组平均7.6个月)、术后末次随访髋关节功能评分(harris hip score,HHS)(A组平均82.6分,B组平均81.1分),两组相比差异无统计学意义(P=0.445);手术时间、术中出血量、术后6个月起立行走测试(time up andgtest,TUG)、术后并发症发生率,两组相比差异均有统计学意义(P<0.05),A组优于B组。结论对老年骨质疏松性31-A3型股骨粗隆间骨折采取钛缆捆扎辅助治疗可降低骨折复杂程度及手术难度、可使患者早期下地活动、减少术后并发症的发生。
Objective To compare the clinical results and complications of PFNA assisted with cable and signal PFNA in the treatment of trochanteric fractures( 31-A3) in the elderly with osteoporosis. Methods Retrospectively analyzing 46 elderly patients with 31-A3 intertrochanteric femoral fractures, who were treated in our hospital from January 2014 to January 2017. For comparison, all patients were divide into 2 groups. Group A( n = 23): PFNA assisted with cable. Group B( n = 23): PFNA. Operation time, intraoperative blood loss, time up and go test 6 months postoperatively, postoperative complication rate, fracture healing time and postoperative hip functions were compared between the 2 groups. Results Forty-three patients were followed up for 12-32 months with an average of 25.4 months. Primary healing was achieved. No infection, neurovascular injury, thrombosis, or fat embolism was observed. There were no significant differences in union time( an average of 7.5 months in Group A and7.6 months in Group B), nor the latest HHS( an average of 82.6 in Group A and 81.1 in Group B) between the 2 groups( P = 0.445). Significant differences were observed in operation time, intraoperative blood loss, time up and go test6 months postoperatively, postoperative complication rate( P < 0.05). While Group A performed better than Group B.Conclusions Internal fixation of PFNA assisted with cable is demonstrated as a feasible, effective and safe treatment of 31-A3 femoral intertrochanteric fractures, which should be considered as a method of priority.
Objective To compare the clinical results and complications of PFNA assisted with cable and signal PFNA in the treatment of trochanteric fractures( 31-A3) in the elderly with osteoporosis. Methods Retrospectively analyzing 46 elderly patients with 31-A3 intertrochanteric femoral fractures, who were treated in our hospital from January 2014 to January 2017. For comparison, all patients were divide into 2 groups. Group A( n = 23): PFNA assisted with cable. Group B( n = 23): PFNA. Operation time, intraoperative blood loss, time up and go test 6 months postoperatively, postoperative complication rate, fracture healing time and postoperative hip functions were compared between the 2 groups. Results Forty-three patients were followed up for 12-32 months with an average of 25.4 months. Primary healing was achieved. No infection, neurovascular injury, thrombosis, or fat embolism was observed. There were no significant differences in union time( an average of 7.5 months in Group A and7.6 months in Group B), nor the latest HHS( an average of 82.6 in Group A and 81.1 in Group B) between the 2 groups( P = 0.445). Significant differences were observed in operation time, intraoperative blood loss, time up and go test6 months postoperatively, postoperative complication rate( P < 0.05). While Group A performed better than Group B.Conclusions Internal fixation of PFNA assisted with cable is demonstrated as a feasible, effective and safe treatment of 31-A3 femoral intertrochanteric fractures, which should be considered as a method of priority.
引文
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[12]Wan L,Song H,Chen X,et al.A magnetic-field guided interface coassembly approach to magnetic mesoporous silica nanochains for osteoclast-targeted inhibition and heterogeneous nanocatalysis[J].Adv Mater,2018,30(25):1707515.
[13]Yu e Q,L i J,Z h a n g Y,e t a l.P l a s m o l y s i s-i n s p i r e d nanoengineering of functional yolk-shell microspheres with magnetic core and mesoporous silica shell[J].J Am Chem Soc,2017,139(43):15486-15493.
[14]Lv C,Fang Y,Liu L,et al.The new proximal femoral nail antirotation-asia:early,results[J].Orthopedics,2011,34(5):351.
[15]Chun YS,Oh H,Cho YJ,et al.Technique and early results of percutaneous reduction of sagittally unstable intertrochateric fractures[J].Clinics Orthop Surg,2011,3(3):217-224.
[16]施保华,尹峰.复杂股骨粗隆间骨折的复位策略与手术技巧[J].中国骨与关节损伤杂志,2013,28(8):769-770.
[17]孙海波,张英泽,彭阿钦,等.PFNA治疗老年股骨转子间骨折围手术期隐性失血量分析[J].中华骨与关节外科杂志,2014,(6):494-497.
[18]Guo W,Wang J,Zhang W,et al.Hidden blood loss and its risk factors after hip hemiarthroplasty for displaced femoral neck fractures:a cross-sectional study[J].Clinic Inter Aging,2018,13:1639-1645.
[19]茹江英,丛宇,仓海斌,等.老年股骨粗隆间骨折PFNA内固定术后失效的翻修方法及效果分析[J].中国骨与关节损伤杂志,2014,29(2):129-131.
[20]Zlowodzki M,Brink O,Switzer J,et al.The effect of shortening and varus collapse of the femoral neck on function after fixation of intracapsular fracture of the hip:a multi-centre cohort study[J].J Bone Joint Surg,2008,90-B(11):1487-1494.
[21]Haidukewych GJ.Intertrochanteric fractures:ten tips to improve results[J].J Bone Joint Surg Am,2009,91(3):712-719.
[2]Si L,Winzenberg TM,Jiang Q,et al.Projection of osteoporosisrelated fractures and costs in China:2010-2050[J].Osteoporos Int,2015,26(7):1929-1937.
[3]Joeris A,Lutz N,Blumenthal A,et al.The AO pediatric comprehensive classification of long bone fractures(PCCF)[J].Acta Orthop,2016,88(2):123-128.
[4]中华医学会骨质疏松和骨矿盐疾病分会.原发性骨质疏松症诊治指南(2011年)[J].中华骨质疏松和骨矿盐疾病杂志,2011,4(1):2-17.
[5]Goffin JM,Pankaj P,Simpson AH,et al.Does bone compaction around the helical bladeof a proximal femoral nail antirotation(PFNA)decrease the riskof cut-out?A subject-specific computational study[J].Bone Joint Res,2013,2(5):79-83.
[6]中华医学会骨科学分会青年骨质疏松学组.中国骨质疏松性骨折围手术期处理专家共识(2018年)[J].中国临床医学,2018,25(5):1-10.
[7]Luciani D,Cadossi M,Mazzotti A,et al.The importance of rehabilitation after lower limb fractures in elderly osteoporotic patients[J].Aging Clinical Experimental Res,2013,25(S1):S113-115.
[8]中华医学会外科学分会血管外科学组.深静脉血栓形成的诊断和治疗指南[J].中华普通外科杂志,2013,23(1):235-238.
[9]Nygard H,Matre K,Fevang JM.Evaluation of timed up and go test as a tool to measure postoperative function and prediction of one year walking ability for patients with hip fracture[J].Clinical Rehabilitation,2015,30(5):472-480.
[10]S?derman P,Malchau H.Is the Harris hip score system useful to study the outcome of total hip replacement[J]?Clinic Orthop Related Res,2001,384(384):189.
[11]Chen X,Zhi X,Wang J,et al.RANKL signaling in bone marrow mesenchymal stem cells negatively regulates osteoblastic bone formation[J].Bone Res,2018,6:34.
[12]Wan L,Song H,Chen X,et al.A magnetic-field guided interface coassembly approach to magnetic mesoporous silica nanochains for osteoclast-targeted inhibition and heterogeneous nanocatalysis[J].Adv Mater,2018,30(25):1707515.
[13]Yu e Q,L i J,Z h a n g Y,e t a l.P l a s m o l y s i s-i n s p i r e d nanoengineering of functional yolk-shell microspheres with magnetic core and mesoporous silica shell[J].J Am Chem Soc,2017,139(43):15486-15493.
[14]Lv C,Fang Y,Liu L,et al.The new proximal femoral nail antirotation-asia:early,results[J].Orthopedics,2011,34(5):351.
[15]Chun YS,Oh H,Cho YJ,et al.Technique and early results of percutaneous reduction of sagittally unstable intertrochateric fractures[J].Clinics Orthop Surg,2011,3(3):217-224.
[16]施保华,尹峰.复杂股骨粗隆间骨折的复位策略与手术技巧[J].中国骨与关节损伤杂志,2013,28(8):769-770.
[17]孙海波,张英泽,彭阿钦,等.PFNA治疗老年股骨转子间骨折围手术期隐性失血量分析[J].中华骨与关节外科杂志,2014,(6):494-497.
[18]Guo W,Wang J,Zhang W,et al.Hidden blood loss and its risk factors after hip hemiarthroplasty for displaced femoral neck fractures:a cross-sectional study[J].Clinic Inter Aging,2018,13:1639-1645.
[19]茹江英,丛宇,仓海斌,等.老年股骨粗隆间骨折PFNA内固定术后失效的翻修方法及效果分析[J].中国骨与关节损伤杂志,2014,29(2):129-131.
[20]Zlowodzki M,Brink O,Switzer J,et al.The effect of shortening and varus collapse of the femoral neck on function after fixation of intracapsular fracture of the hip:a multi-centre cohort study[J].J Bone Joint Surg,2008,90-B(11):1487-1494.
[21]Haidukewych GJ.Intertrochanteric fractures:ten tips to improve results[J].J Bone Joint Surg Am,2009,91(3):712-719.