InterTan髓内钉与解剖型股骨近端髓内钉治疗老年股骨转子间骨折的疗效比较
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摘要
为探讨Inter Tan髓内钉与解剖型股骨近端髓内钉(ZNN)治疗老年股骨转子间骨折的临床疗效,通过回顾性研究方法研究从2013年1月～2018年1月的年龄大于65岁的股骨转子间骨折患者。最终收入114例。其中男性56例,女性58例。平均年龄为77. 88岁。采用Inter Tan髓内钉治疗69例,ZNN髓内钉治疗45例。比较两组患者手术时长,术中出血量,术后第3 d、第7 d,以及术后1月、3月视觉模拟评分。术后并发症以及术后3月、6月髋关节Harris评分。结果表明两组患者手术时长具有统计学差异(P <0. 01),Inter Tan髓内钉组手术时长较长。两组术中出血量没有统计学差异(P=0. 12)。两组患者术后第3 d、第7 d,以及术后1月、3月视觉模拟评分没有统计学差异(P=0. 77、P=0. 06、P=0. 32、P=0. 56)。术后3月、6月髋关节Harris评分,两组患者没有统计学差异(P=0. 39、P=0. 27)。两组均未有患者出现伤口感染,内固定失败,假体周围骨折等并发症。可见短期随访研究对于老年股骨转子间骨折,采用ZNN髓内钉与Inter Tan髓内钉均可以获得满意疗效。但是In-ter Tan髓内钉操作步骤复杂,手术时长较长,所以对于手术耐受能力较差的患者,推荐采用ZNN髓内钉进行固定。
In order to investigate the clinical efficacy of InterTan intramedullary nail and zimmer natural nail system( ZNN) in the treatment of intertrochanteric fractures in the elderly. Patients with femoral intertrochanteric fractures older than 65 years who were treated from January 2013 to January 2018 were enrolled. A total of 114 patients were eventually included. There were 56 males and 58 females. The average age was 77. 88 years. 69 patients underwent InterTan intramedullary nailing and 45 patients underwent ZNN intramedullary nail. The duration of operation,the amount of intraoperative blood loss,the visual analogue scale( VAS) of third day,seventh day after surgery,and the first and third months after surgery were compared between the two groups. Postoperative complications and hip Harris scores in the first and third months after surgery were also recorded. The results show that there is a statistically significant difference in the duration of surgery between the two groups( P < 0. 01). The InterTan intramedullary nail fixation group has a longer duration of surgery. There is no significant difference in intraoperative blood loss between the two groups( P = 0. 12). There are no significant differences in VAS scores between the two groups on the 3 rd day,7 th day,and 1 st and 3 rd month after surgery( P = 0. 77,P = 0. 06,P =0. 32,P = 0. 56). No statistically different between the two groups at hip Harris scores on the 3 rd and 6 th month after surgery( P = 0. 39,P = 0. 27). There are no complications such as wound infection,internal fixation failure,and periprosthetic fracture. It is concluded that the short-term follow-up study finds that ZNN and InterTan intramedullary nails can achieve satisfactory results in the treatment of intertrochanteric fractures in the elderly. However,InterTan intramedullary nails have complicated operation steps and long operation time. Therefore,ZNN intramedullary nails are recommended for patients with poor surgical tolerance.
In order to investigate the clinical efficacy of InterTan intramedullary nail and zimmer natural nail system( ZNN) in the treatment of intertrochanteric fractures in the elderly. Patients with femoral intertrochanteric fractures older than 65 years who were treated from January 2013 to January 2018 were enrolled. A total of 114 patients were eventually included. There were 56 males and 58 females. The average age was 77. 88 years. 69 patients underwent InterTan intramedullary nailing and 45 patients underwent ZNN intramedullary nail. The duration of operation,the amount of intraoperative blood loss,the visual analogue scale( VAS) of third day,seventh day after surgery,and the first and third months after surgery were compared between the two groups. Postoperative complications and hip Harris scores in the first and third months after surgery were also recorded. The results show that there is a statistically significant difference in the duration of surgery between the two groups( P < 0. 01). The InterTan intramedullary nail fixation group has a longer duration of surgery. There is no significant difference in intraoperative blood loss between the two groups( P = 0. 12). There are no significant differences in VAS scores between the two groups on the 3 rd day,7 th day,and 1 st and 3 rd month after surgery( P = 0. 77,P = 0. 06,P =0. 32,P = 0. 56). No statistically different between the two groups at hip Harris scores on the 3 rd and 6 th month after surgery( P = 0. 39,P = 0. 27). There are no complications such as wound infection,internal fixation failure,and periprosthetic fracture. It is concluded that the short-term follow-up study finds that ZNN and InterTan intramedullary nails can achieve satisfactory results in the treatment of intertrochanteric fractures in the elderly. However,InterTan intramedullary nails have complicated operation steps and long operation time. Therefore,ZNN intramedullary nails are recommended for patients with poor surgical tolerance.
引文
1 Socci A R,Casemyr N E,Leslie M P,et al.Implant options for the treatment of intertrochanteric fractures of the hip:rationale,evidence,and recommendations[J].Bone&Joint Journal,2017,99-B(1):128-133
2 Zeng X,Nan Z,Dan Z,et al.Proximal femoral nail antirotation versus dynamic hip screw fixation for treatment of osteoporotic type 31-a1intertrochanteric femoral fractures in elderly patients[J].Journal of International Medical Research,2017,45(3):1109-1123
3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):1868-1872Zhang Shimin,Zhu Xiaozhong,Huang Yigang,et al.Extramedullary dhs and intramedullary pfna in unstable pertrochanteric fractures with lateral wall risky AO/OTA type 31A2.2 and A2.3:a clinical retrospective comparison[J].Orthopedic Journal of China,2010,18(22):1868-1872
4 France W G,Berkin C R.Trochanteric fractures of the femur[J].British Journal of Surgery,2010,39(154):166-172
5李建赤,刘岗,薛小华,等.老年人股骨转子间骨折PFNA和DHS内固定术疗效的临床研究[J].中国临床解剖学杂志,2017,35(5):571-575Li Jianchi,Liu Gang,Xue Xiaohua,et al.The clinical study of pfna and DHS internal fixation for intertrochanteric fracture in the elderly[J].Chinese Journal of Clinical Anatomy,2017,35(5):571-575
6白志刚,宋强,程锁利,等.四种手术方式治疗高龄骨质疏松性股骨转子间骨折的回顾性分析[J].中国骨质疏松杂志,2017,23(6):790-794Bai Zhigang,Song Qiang,Cheng Suoli,et al.Retrospective analysis of the four surgical patterns for the treatment of osteoporotic intertrochanter fractures in the elderly[J].Chinese Journal of Osteoporosis,2017,23(6):790-794
7 Berger-Groch J,Rupprecht M,Schoepper S,et al.5 years outcome analysis of intertrochanteric femur fractures:A prospective randomized trial comparing a two-screw and a single-screw cephalomedullary nail[J].Journal of Orthopaedic Trauma,2016,30(9):483-488
8王卫东,白峰.人工股骨头置换术与PFNA内固定治疗高龄不稳定型股骨粗隆间骨折的疗效比较[J].科学技术与工程,2012,12(35):9640-9643Wang Weidong,Bai Feng.Clinical study of pfna fixation and hemiarthroplasty in the treatment of unstable intertrochanteric femoral fractures in elder patients[J].Science Technology and Engineering,2012,12(35):9640-9643
9 Serrano R,Blair J A,Watson D T,et al.Cephalomedullary nail fixation of intertrochanteric fractures:are two proximal screws better than one?[J]Journal of Orthopaedic Trauma,2017,31(11):577-582
10张雪鹏,杨金锁.小转子未固定的PFNA治疗Evans-JensenⅢ型转子间骨折的有限元分析[J].科学技术与工程,2016,16(15):144-148Zhang Xuepeng,Yang Jinsuo.Finite element analysis of pfna treated Evans-jensenⅢtype intertrochanteric fracture with unfixed femur lesser trochanter[J].Science Technology and Engineering,2016,16(15):144-148
11 Shin Y S,Chae J E,Kang T W,et al.Prospective randomized study comparing two cephalomedullary nails for elderly intertrochanteric fractures:zimmer natural nail versus proximal femoral nail antirotation II[J].Injury-international Journal of the Care of the Injured,2017,48(7):1550-1557
12刘中砥,徐海林,陈建海,等.解剖型股骨近端髓内钉治疗老年转子间骨折的初步疗效[J].中华老年骨科与康复电子杂志,2017,3(5):265-269Liu Zhongyu,Xu Hailin,Chen Jianhai,et al.Clinical effectiveness of zimmer natural nail system(ZNN)for treatment of elderly intertrochanteric fractures[J].Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition),2017,3(5):265-269
13秦晖,安智全.InterTan治疗股骨粗隆间骨折的疗效评估[J].中国修复重建外科杂志,2010(12):1424-1427Qin Hui,An Zhiquan.Therapeutic evaluation of femoral intertrochanteric fractures by InterTan[J].Chinese Journal of Reparative and Reconstructive Surgery,2010(12):1424-1427
14杨飞,韩启明,杨凤明,等.老年股骨粗隆间骨折微创IN-TERTAN髓内钉与PFNA-Ⅱ髓内钉临床疗效分析[J].中国矫形外科杂志,2015,23(10):897-901Yang Fei,Han Qiming,Yang Fengming,et al.Elderly femoral intertrochanteric fractures by using minimally invasive InterTan intramedullary nail or PFNA-Ⅱintramedullary nail[J].Orthopedic Journal of China,2015,23(10):897-901
15陈伯亮,魏玉珊,赵轶男,等.InterTan髓内钉、PFNA内固定术治疗老年不稳定型股骨粗隆间骨折围手术期失血量对比观察[J].山东医药,2017,57(31):67-70Chen Boliang,Wei Yushan,Zhao Yunan,et al.Comparison of Inter Tan intramedullary nail and PFNA internal fixation for perioperative blood loss in elderly patients with unstable intertrochanteric fractures[J].Shandong Medical Journal,2017,57(31):67-70
16 Sanders D,Bryant D,Tieszer C,et al.A multi-centre randomized control trial comparing a novel intramedullary device(InterTan)versus conventional treatment(Sliding Hip Screw)of geriatric hip fractures[J].Journal of Orthopaedic Trauma,2016,31(1):1-8
17 Niu E,Yang A,Harris A H S,et al.Which fixation device is preferred for surgical treatment of intertrochanteric hip fractures in the united states?a survey of orthopaedic surgeons[J].Clinical Orthopaedics&Related Research?,2015,473(11):3647-3655
18 Yu W,Zhang X,Wu R,et al.The visible and hidden blood loss of asia proximal femoral nail anti-rotation and dynamic hip screw in the treatment of intertrochanteric fractures of elderly high-risk patients:A retrospective comparative study with a minimum 3 years of followup[J].Bmc Musculoskeletal Disorders,2016,17(1):269-302
19 Akan K,Cift H,Ozkan K,et al.Effect of osteoporosis on clinical outcomes in intertrochanteric hip fractures treated with a proximal femoral nail[J].Journal of International Medical Research,2011,39(3):857-865
20李凡,陆海明,王秋根,等.PFNA与Gamma钉治疗不稳定股骨粗隆间骨折的早期疗效评价[J].中国矫形外科杂志,2008,16(16):1265-1267Li Fan,Lu Haiming,Wang Qiugen,et al.Early evaluation of the curative effect of unstable peritrochanteric fractures treatments with PFNA and Gamma nail[J].Orthopedic Journal of China,2008,16(16):1265-1267
21侯宇,姚琦,张亘瑷,等.第三代Gamma钉与防旋股骨近端髓内钉治疗股骨粗隆间骨折术后股骨近端短缩的比较研究[J].中国修复重建外科杂志,2018(3):338-345Hou Yu,Yao Qi,Zhang Genai,et al.Comparative study of proximal femoral shortening after the third generation of gamma nail versus proximal femoral nail anti-rotation in treatment of intertrochanteric fracture[J].Chinese Journal of Reparative and Reconstructive Surgery,2018(3):338-345
22 Santoso A,Choi I S,Park K S,et al.Breakage of the tail portion of the lag screw during removal of proximal femoral zimmer natural nail:report of two cases with technical notes[J].Hip&Pelvis,2017,29(3):199-203
2 Zeng X,Nan Z,Dan Z,et al.Proximal femoral nail antirotation versus dynamic hip screw fixation for treatment of osteoporotic type 31-a1intertrochanteric femoral fractures in elderly patients[J].Journal of International Medical Research,2017,45(3):1109-1123
3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):1868-1872Zhang Shimin,Zhu Xiaozhong,Huang Yigang,et al.Extramedullary dhs and intramedullary pfna in unstable pertrochanteric fractures with lateral wall risky AO/OTA type 31A2.2 and A2.3:a clinical retrospective comparison[J].Orthopedic Journal of China,2010,18(22):1868-1872
4 France W G,Berkin C R.Trochanteric fractures of the femur[J].British Journal of Surgery,2010,39(154):166-172
5李建赤,刘岗,薛小华,等.老年人股骨转子间骨折PFNA和DHS内固定术疗效的临床研究[J].中国临床解剖学杂志,2017,35(5):571-575Li Jianchi,Liu Gang,Xue Xiaohua,et al.The clinical study of pfna and DHS internal fixation for intertrochanteric fracture in the elderly[J].Chinese Journal of Clinical Anatomy,2017,35(5):571-575
6白志刚,宋强,程锁利,等.四种手术方式治疗高龄骨质疏松性股骨转子间骨折的回顾性分析[J].中国骨质疏松杂志,2017,23(6):790-794Bai Zhigang,Song Qiang,Cheng Suoli,et al.Retrospective analysis of the four surgical patterns for the treatment of osteoporotic intertrochanter fractures in the elderly[J].Chinese Journal of Osteoporosis,2017,23(6):790-794
7 Berger-Groch J,Rupprecht M,Schoepper S,et al.5 years outcome analysis of intertrochanteric femur fractures:A prospective randomized trial comparing a two-screw and a single-screw cephalomedullary nail[J].Journal of Orthopaedic Trauma,2016,30(9):483-488
8王卫东,白峰.人工股骨头置换术与PFNA内固定治疗高龄不稳定型股骨粗隆间骨折的疗效比较[J].科学技术与工程,2012,12(35):9640-9643Wang Weidong,Bai Feng.Clinical study of pfna fixation and hemiarthroplasty in the treatment of unstable intertrochanteric femoral fractures in elder patients[J].Science Technology and Engineering,2012,12(35):9640-9643
9 Serrano R,Blair J A,Watson D T,et al.Cephalomedullary nail fixation of intertrochanteric fractures:are two proximal screws better than one?[J]Journal of Orthopaedic Trauma,2017,31(11):577-582
10张雪鹏,杨金锁.小转子未固定的PFNA治疗Evans-JensenⅢ型转子间骨折的有限元分析[J].科学技术与工程,2016,16(15):144-148Zhang Xuepeng,Yang Jinsuo.Finite element analysis of pfna treated Evans-jensenⅢtype intertrochanteric fracture with unfixed femur lesser trochanter[J].Science Technology and Engineering,2016,16(15):144-148
11 Shin Y S,Chae J E,Kang T W,et al.Prospective randomized study comparing two cephalomedullary nails for elderly intertrochanteric fractures:zimmer natural nail versus proximal femoral nail antirotation II[J].Injury-international Journal of the Care of the Injured,2017,48(7):1550-1557
12刘中砥,徐海林,陈建海,等.解剖型股骨近端髓内钉治疗老年转子间骨折的初步疗效[J].中华老年骨科与康复电子杂志,2017,3(5):265-269Liu Zhongyu,Xu Hailin,Chen Jianhai,et al.Clinical effectiveness of zimmer natural nail system(ZNN)for treatment of elderly intertrochanteric fractures[J].Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition),2017,3(5):265-269
13秦晖,安智全.InterTan治疗股骨粗隆间骨折的疗效评估[J].中国修复重建外科杂志,2010(12):1424-1427Qin Hui,An Zhiquan.Therapeutic evaluation of femoral intertrochanteric fractures by InterTan[J].Chinese Journal of Reparative and Reconstructive Surgery,2010(12):1424-1427
14杨飞,韩启明,杨凤明,等.老年股骨粗隆间骨折微创IN-TERTAN髓内钉与PFNA-Ⅱ髓内钉临床疗效分析[J].中国矫形外科杂志,2015,23(10):897-901Yang Fei,Han Qiming,Yang Fengming,et al.Elderly femoral intertrochanteric fractures by using minimally invasive InterTan intramedullary nail or PFNA-Ⅱintramedullary nail[J].Orthopedic Journal of China,2015,23(10):897-901
15陈伯亮,魏玉珊,赵轶男,等.InterTan髓内钉、PFNA内固定术治疗老年不稳定型股骨粗隆间骨折围手术期失血量对比观察[J].山东医药,2017,57(31):67-70Chen Boliang,Wei Yushan,Zhao Yunan,et al.Comparison of Inter Tan intramedullary nail and PFNA internal fixation for perioperative blood loss in elderly patients with unstable intertrochanteric fractures[J].Shandong Medical Journal,2017,57(31):67-70
16 Sanders D,Bryant D,Tieszer C,et al.A multi-centre randomized control trial comparing a novel intramedullary device(InterTan)versus conventional treatment(Sliding Hip Screw)of geriatric hip fractures[J].Journal of Orthopaedic Trauma,2016,31(1):1-8
17 Niu E,Yang A,Harris A H S,et al.Which fixation device is preferred for surgical treatment of intertrochanteric hip fractures in the united states?a survey of orthopaedic surgeons[J].Clinical Orthopaedics&Related Research?,2015,473(11):3647-3655
18 Yu W,Zhang X,Wu R,et al.The visible and hidden blood loss of asia proximal femoral nail anti-rotation and dynamic hip screw in the treatment of intertrochanteric fractures of elderly high-risk patients:A retrospective comparative study with a minimum 3 years of followup[J].Bmc Musculoskeletal Disorders,2016,17(1):269-302
19 Akan K,Cift H,Ozkan K,et al.Effect of osteoporosis on clinical outcomes in intertrochanteric hip fractures treated with a proximal femoral nail[J].Journal of International Medical Research,2011,39(3):857-865
20李凡,陆海明,王秋根,等.PFNA与Gamma钉治疗不稳定股骨粗隆间骨折的早期疗效评价[J].中国矫形外科杂志,2008,16(16):1265-1267Li Fan,Lu Haiming,Wang Qiugen,et al.Early evaluation of the curative effect of unstable peritrochanteric fractures treatments with PFNA and Gamma nail[J].Orthopedic Journal of China,2008,16(16):1265-1267
21侯宇,姚琦,张亘瑷,等.第三代Gamma钉与防旋股骨近端髓内钉治疗股骨粗隆间骨折术后股骨近端短缩的比较研究[J].中国修复重建外科杂志,2018(3):338-345Hou Yu,Yao Qi,Zhang Genai,et al.Comparative study of proximal femoral shortening after the third generation of gamma nail versus proximal femoral nail anti-rotation in treatment of intertrochanteric fracture[J].Chinese Journal of Reparative and Reconstructive Surgery,2018(3):338-345
22 Santoso A,Choi I S,Park K S,et al.Breakage of the tail portion of the lag screw during removal of proximal femoral zimmer natural nail:report of two cases with technical notes[J].Hip&Pelvis,2017,29(3):199-203