股骨近端防旋髓内钉与人工股骨头置换术治疗老年不稳定股骨转子间骨折的比较研究
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摘要
目的:比较股骨近端防旋髓内钉(PFNA)与人工股骨头置换术(FHR)治疗老年不稳定股骨转子间骨折(UFIF)的疗效。方法:选择2015年9月到2017年6月期间在我院接受手术治疗的老年UFIF患者156例进行研究。根据手术方案的不同将患者分成观察组(n=78)及对照组(n=78),其中观察组给予FHR术式治疗,对照组给予PFNA术式治疗,随访6个月,比较两组患者的疗效、并发症以及手术时间、切口长度、术中出血量、下床时间等手术指标,并比较两组患者术前、术后1个月、术后3个月、术后6个月的视觉模拟量表(VAS)评分。结果:观察组的优良率为92.31%,与对照组的88.46%相比,差异无统计学意义(P>0.05)。观察组的下床时间明显少于对照组,但手术时间、切口长度以及术中出血量明显大于对照组(P<0.05)。观察组术后输血的发生率明显高于对照组(P<0.05),而两组患者的内植物松动、骨折不愈合以及下肢深静脉血栓的发生率比较差异无统计学意义(P>0.05)。两组患者术后1个月、术后3个月、术后6个月的VAS评分均低于术前,且随着时间的推移,VAS评分呈逐渐降低的趋势,差异有统计学意义(P<0.05)。结论:对于老年UFIF患者而言,PFNA术式及FHR术式的治疗效果及安全性均较好,临床上可根据患者的实际骨折程度选择合适的术式。
Objective: To compare the therapeutic effect of proximal femoral nail antirotation(PFNA) and artificial femoral head replacement(FHR) in the treatment of unstable femoral intertrochanteric fractures(UFIF) in the elderly. Methods: 156 elderly patients with UFIF who were underwent surgical treatment in our hospital from September 2015 to June 2017 were selected to carry out research.The patients were divided into the observation group(n=78) and the control group(n=78) according to the different surgical procedures.The observation group was treated with FHR, and the control group was treated with PFNA. The patients were followed up for 6 months,the effects, complications, the operative time, incision length, intraoperative bleeding volume and out of bed time were observed in the two groups, the visual analogue scale(VAS) scores of two groups before operation, 1 months after operation, 3 months after operation and 6 months after operation were evaluated. Results: The excellent and good rate of the observation group was 92.31%, compared with88.46% of the control group, the difference was not statistically significant(P>0.05). The out of bed time in the observation group was significantly less than the control group, however, the operative time, incision length and intraoperative bleeding volume were significantly higher than the control group(P <0.05). The incidence of postoperative blood transfusion in the observation group was significantly higher than that of the control group(P <0.05), there was no significant difference in the incidence of internal plant loosening, nonunion of fracture and deep vein thrombosis of lower extremities in the two groups(P>0.05). The VAS scores of patients in two groups at 1 months, 3 months and 6 months after operation were all lower than those before operation, and the VAS score was gradually decreased with time going on, the difference was statistically significant(P<0.05). Conclusion: The effect and safety of PFNA and FHR were better for the elderly UFIF patients. The appropriate surgical procedure can be selected according to the actual degree of fracture of the patient.
Objective: To compare the therapeutic effect of proximal femoral nail antirotation(PFNA) and artificial femoral head replacement(FHR) in the treatment of unstable femoral intertrochanteric fractures(UFIF) in the elderly. Methods: 156 elderly patients with UFIF who were underwent surgical treatment in our hospital from September 2015 to June 2017 were selected to carry out research.The patients were divided into the observation group(n=78) and the control group(n=78) according to the different surgical procedures.The observation group was treated with FHR, and the control group was treated with PFNA. The patients were followed up for 6 months,the effects, complications, the operative time, incision length, intraoperative bleeding volume and out of bed time were observed in the two groups, the visual analogue scale(VAS) scores of two groups before operation, 1 months after operation, 3 months after operation and 6 months after operation were evaluated. Results: The excellent and good rate of the observation group was 92.31%, compared with88.46% of the control group, the difference was not statistically significant(P>0.05). The out of bed time in the observation group was significantly less than the control group, however, the operative time, incision length and intraoperative bleeding volume were significantly higher than the control group(P <0.05). The incidence of postoperative blood transfusion in the observation group was significantly higher than that of the control group(P <0.05), there was no significant difference in the incidence of internal plant loosening, nonunion of fracture and deep vein thrombosis of lower extremities in the two groups(P>0.05). The VAS scores of patients in two groups at 1 months, 3 months and 6 months after operation were all lower than those before operation, and the VAS score was gradually decreased with time going on, the difference was statistically significant(P<0.05). Conclusion: The effect and safety of PFNA and FHR were better for the elderly UFIF patients. The appropriate surgical procedure can be selected according to the actual degree of fracture of the patient.
引文
[1]Nie B,Chen X,Li J,et al.The medial femoral wall can play a more important role in unstable intertrochanteric fractures compared with lateral femoral wall:a biomechanical study[J].J Orthop Surg Res2017,12(1):197
[2]Chua IT,Rajamoney GN,Kwek EB,et al.Cephalomedullary nai versus sliding hip screw for unstable intertrochanteric fractures in elderly patients[J].J Orthop Surg(Hong Kong),2013,21(3):308-312
[3]Hong JB,Dan Y,Ouyang L,et al.Biomechanical study on differen lengths of PFNA fixation for unstable intertrochanteric femora fractures[J].J Musculoskelet Neuronal Interact,2017,17(4):299-302
[4]Sonmez MM,Camur S,Erturer E,et al.Strategies for Proxima Femoral Nailing of Unstable Intertrochanteric Fractures:Latera Decubitus Position or Traction Table[J].J Am Acad Orthop Surg,2017,25(3):e37-e44
[5]Sahin EK,Imerci A,K覦n覦k H,et al.Comparison of proximal femoral nail antirotation(PFNA)with AO dynamic condylar screws(DCS)for the treatment for unstable peritrochanteric femoral fractures[J].Eur JOrthop Surg Traumatol,2014,24(3):347-352
[6]Cui Q,Liu YS,Li DF,et al.Cemented hip hemiarthroplasty clinical observations on unstable intertrochanteric fracture in elderlies[J].Eur J Trauma Emerg Surg,2016,42(5):651-656
[7]成世高,王万春,肖扬,等.骨水泥型人工股骨头置换治疗高龄不稳定型股骨转子间骨折[J].中国组织工程研究,2015,19(52):8373-8378
[8]Kim JT,Kim HH,Kim JH,et al.Mid-Term Survivals After Cementless Bipolar Hemiarthroplasty for Unstable Intertrochanteric Fractures in Elderly Patients[J].J Arthroplasty,2018,33(3):777-782
[9]Li J,Cheng L,Jing J,et al.The Asia proximal femoral nail antirotation versus the standard proximal femoral antirotation nail for unstable intertrochanteric fractures in elderly Chinese patients[J].Orthop Traumatol Surg Res,2015,101(2):143-146
[10]张力鹏,孟国林,刘建,等.InterTan髓内钉治疗老年骨质疏松患者股骨转子间骨折[J].现代生物医学进展,2016,16(10):1858-1861,1900
[11]Chang JD,Kim IS,Lee SS,et al.Unstable intertrochanteric versus displaced femoral neck fractures treated with cementless bipolar hemiarthroplasty in elderly patients;a comparison of 80 matched patients[J].Orthop Traumatol Surg Res,2016,102(6):695-699
[12]Jiang X,Wang Y,Ma X,et al.Proximal Femoral Nail Antirotation Versus Reverse Less Invasive Stabilization System-distal Femur for Treating Proximal Femoral Fractures:A Meta-analysis[J].Medicine(Baltimore),2016,95(14):e3168
[13]Huang SG,Chen B,Zhang Y,et al.Comparison of the Clinical Effectiveness of PFNA,PFLCP,and DHS in Treatment of Unstable Intertrochanteric Femoral Fracture[J].Am J Ther,2017,24(6):e659-e666
[14]Singh S,Shrivastava C,Kumar S.Hemi replacement arthroplasty for unstable inter-trochanteric fractures of femur[J].J Clin Diagn Res,2014,8(10):LC01-LC04
[15]曾荣东,林金丁,黄杰聪,等.股骨近端防旋髓内钉和人工股骨头置换治疗老年股骨转子间骨折的疗效比较[J].中华创伤杂志,2016,32(8):701-706
[16]Sahin EK,Imerci A,K覦n覦k H,et al.Comparison of proximal femoral nail antirotation(PFNA)with AO dynamic condylar screws(DCS)for the treatment for unstable peritrochanteric femoral fractures[J].Eur JOrthop Surg Traumatol,2014,24(3):347-352
[17]Sharma A,Mahajan A,John B,et al.A Comparison of the Clinico-Radiological Outcomes with Proximal Femoral Nail(PFN)and Proximal Femoral Nail Antirotation(PFNA)in Fixation of Unstable Intertrochanteric Fractures[J].J Clin Diagn Res,2017,11(7):RC05-RC09
[18]Ding DY,Christoforou D,Turner G,et al.Postoperative stroke after hemiarthroplasty for femoral neck fracture:a report of 2 cases and review of literature[J].J Patient Saf,2014,10(2):117-120
[19]Sadic S,Custovic S,Jasarevuc M,et al.Proximal Femoral Nail Antirotation in Treatment of Intertrochanteric Hip Fractures:a Retrospective Study in 113 Patients[J].Med Arch,2015,69(6):352-356
[20]Li J,Xu XZ,You T,et al.Early results of the proximal femoral nail antirotation-Asia for intertrochanteric fractures in elderly Chinese patients[J].Saudi Med J,2014,35(4):385-390
[21]Chen Y,Liu S,Lin P,et al.Comparative biomechanical study of reversed less invasive stabilization system and proximal femoral nail antirotation for unstable intertrochanteric fractures[J].Chin Med J(Engl),2014,127(23):4124-4129
[22]Zhang S,Zhang K,Jia Y,et al.InterTan nail versus Proximal Femoral Nail Antirotation-Asia in the treatment of unstable trochanteric fractures[J].Orthopedics,2013,36(3):e288-e294
[23]Oshima H,Tanaka S,Takatori Y,et al.Clinical and Radiographic Outcomes of Total Hip Arthroplasty With a Specific Liner in Small Asian Patients:Influence of Patient-Related,Implant-Related,and Surgical Factors on Femoral Head Penetration[J].J Arthroplasty,2017,32(10):3065-3070
[24]陈述祥,刘彦,陈丽君,等.老年股骨转子间骨折不同治疗方法的评价[J].暨南大学学报(自然科学与医学版),2014,35(2):177-181
[25]Ma KL,Wang X,Luan FJ,et al.Proximal femoral nails antirotation,Gamma nails,and dynamic hip screws for fixation of intertrochanteric fractures of femur:A meta-analysis[J].Orthop Traumatol Surg Res,2014,100(8):859-866
[26]Nherera L,Trueman P,Horner A,et al.Comparison of a twin interlocking derotation and compression screw cephalomedullary nail(InterTAN)with a single screw derotation cephalomedullary nail(proximal femoral nail antirotation):a systematic review and meta-analysis for intertrochanteric fractures[J].J Orthop Surg Res,2018,13(1):46
[27]Ma JX,Wang J,Xu WG,et al.Biomechanical outcome of proximal femoral nail antirotation is superior to proximal femoral locking compression plate for reverse oblique intertrochanteric fractures:a biomechanical study of intertrochanteric fractures[J].Acta Orthop Traumatol Turc,2015,49(4):426-432
[28]Ma JX,Kuang MJ,Fan ZR,et al.Comparison of clinical outcomes with InterTan vs Gamma nail or PFNA in the treatment of intertrochanteric fractures:A meta-analysis[J].Sci Rep,2017,7(1):15962
[29]Sehmisch S,Rieckenberg J,Dresing K,et al.Stabilization of unstable intertrochanteric fractures with the proximal femoral nail[J].Oper Orthop Traumatol,2013,25(1):63-83,quiz 83-84
[30]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):790-794
[2]Chua IT,Rajamoney GN,Kwek EB,et al.Cephalomedullary nai versus sliding hip screw for unstable intertrochanteric fractures in elderly patients[J].J Orthop Surg(Hong Kong),2013,21(3):308-312
[3]Hong JB,Dan Y,Ouyang L,et al.Biomechanical study on differen lengths of PFNA fixation for unstable intertrochanteric femora fractures[J].J Musculoskelet Neuronal Interact,2017,17(4):299-302
[4]Sonmez MM,Camur S,Erturer E,et al.Strategies for Proxima Femoral Nailing of Unstable Intertrochanteric Fractures:Latera Decubitus Position or Traction Table[J].J Am Acad Orthop Surg,2017,25(3):e37-e44
[5]Sahin EK,Imerci A,K覦n覦k H,et al.Comparison of proximal femoral nail antirotation(PFNA)with AO dynamic condylar screws(DCS)for the treatment for unstable peritrochanteric femoral fractures[J].Eur JOrthop Surg Traumatol,2014,24(3):347-352
[6]Cui Q,Liu YS,Li DF,et al.Cemented hip hemiarthroplasty clinical observations on unstable intertrochanteric fracture in elderlies[J].Eur J Trauma Emerg Surg,2016,42(5):651-656
[7]成世高,王万春,肖扬,等.骨水泥型人工股骨头置换治疗高龄不稳定型股骨转子间骨折[J].中国组织工程研究,2015,19(52):8373-8378
[8]Kim JT,Kim HH,Kim JH,et al.Mid-Term Survivals After Cementless Bipolar Hemiarthroplasty for Unstable Intertrochanteric Fractures in Elderly Patients[J].J Arthroplasty,2018,33(3):777-782
[9]Li J,Cheng L,Jing J,et al.The Asia proximal femoral nail antirotation versus the standard proximal femoral antirotation nail for unstable intertrochanteric fractures in elderly Chinese patients[J].Orthop Traumatol Surg Res,2015,101(2):143-146
[10]张力鹏,孟国林,刘建,等.InterTan髓内钉治疗老年骨质疏松患者股骨转子间骨折[J].现代生物医学进展,2016,16(10):1858-1861,1900
[11]Chang JD,Kim IS,Lee SS,et al.Unstable intertrochanteric versus displaced femoral neck fractures treated with cementless bipolar hemiarthroplasty in elderly patients;a comparison of 80 matched patients[J].Orthop Traumatol Surg Res,2016,102(6):695-699
[12]Jiang X,Wang Y,Ma X,et al.Proximal Femoral Nail Antirotation Versus Reverse Less Invasive Stabilization System-distal Femur for Treating Proximal Femoral Fractures:A Meta-analysis[J].Medicine(Baltimore),2016,95(14):e3168
[13]Huang SG,Chen B,Zhang Y,et al.Comparison of the Clinical Effectiveness of PFNA,PFLCP,and DHS in Treatment of Unstable Intertrochanteric Femoral Fracture[J].Am J Ther,2017,24(6):e659-e666
[14]Singh S,Shrivastava C,Kumar S.Hemi replacement arthroplasty for unstable inter-trochanteric fractures of femur[J].J Clin Diagn Res,2014,8(10):LC01-LC04
[15]曾荣东,林金丁,黄杰聪,等.股骨近端防旋髓内钉和人工股骨头置换治疗老年股骨转子间骨折的疗效比较[J].中华创伤杂志,2016,32(8):701-706
[16]Sahin EK,Imerci A,K覦n覦k H,et al.Comparison of proximal femoral nail antirotation(PFNA)with AO dynamic condylar screws(DCS)for the treatment for unstable peritrochanteric femoral fractures[J].Eur JOrthop Surg Traumatol,2014,24(3):347-352
[17]Sharma A,Mahajan A,John B,et al.A Comparison of the Clinico-Radiological Outcomes with Proximal Femoral Nail(PFN)and Proximal Femoral Nail Antirotation(PFNA)in Fixation of Unstable Intertrochanteric Fractures[J].J Clin Diagn Res,2017,11(7):RC05-RC09
[18]Ding DY,Christoforou D,Turner G,et al.Postoperative stroke after hemiarthroplasty for femoral neck fracture:a report of 2 cases and review of literature[J].J Patient Saf,2014,10(2):117-120
[19]Sadic S,Custovic S,Jasarevuc M,et al.Proximal Femoral Nail Antirotation in Treatment of Intertrochanteric Hip Fractures:a Retrospective Study in 113 Patients[J].Med Arch,2015,69(6):352-356
[20]Li J,Xu XZ,You T,et al.Early results of the proximal femoral nail antirotation-Asia for intertrochanteric fractures in elderly Chinese patients[J].Saudi Med J,2014,35(4):385-390
[21]Chen Y,Liu S,Lin P,et al.Comparative biomechanical study of reversed less invasive stabilization system and proximal femoral nail antirotation for unstable intertrochanteric fractures[J].Chin Med J(Engl),2014,127(23):4124-4129
[22]Zhang S,Zhang K,Jia Y,et al.InterTan nail versus Proximal Femoral Nail Antirotation-Asia in the treatment of unstable trochanteric fractures[J].Orthopedics,2013,36(3):e288-e294
[23]Oshima H,Tanaka S,Takatori Y,et al.Clinical and Radiographic Outcomes of Total Hip Arthroplasty With a Specific Liner in Small Asian Patients:Influence of Patient-Related,Implant-Related,and Surgical Factors on Femoral Head Penetration[J].J Arthroplasty,2017,32(10):3065-3070
[24]陈述祥,刘彦,陈丽君,等.老年股骨转子间骨折不同治疗方法的评价[J].暨南大学学报(自然科学与医学版),2014,35(2):177-181
[25]Ma KL,Wang X,Luan FJ,et al.Proximal femoral nails antirotation,Gamma nails,and dynamic hip screws for fixation of intertrochanteric fractures of femur:A meta-analysis[J].Orthop Traumatol Surg Res,2014,100(8):859-866
[26]Nherera L,Trueman P,Horner A,et al.Comparison of a twin interlocking derotation and compression screw cephalomedullary nail(InterTAN)with a single screw derotation cephalomedullary nail(proximal femoral nail antirotation):a systematic review and meta-analysis for intertrochanteric fractures[J].J Orthop Surg Res,2018,13(1):46
[27]Ma JX,Wang J,Xu WG,et al.Biomechanical outcome of proximal femoral nail antirotation is superior to proximal femoral locking compression plate for reverse oblique intertrochanteric fractures:a biomechanical study of intertrochanteric fractures[J].Acta Orthop Traumatol Turc,2015,49(4):426-432
[28]Ma JX,Kuang MJ,Fan ZR,et al.Comparison of clinical outcomes with InterTan vs Gamma nail or PFNA in the treatment of intertrochanteric fractures:A meta-analysis[J].Sci Rep,2017,7(1):15962
[29]Sehmisch S,Rieckenberg J,Dresing K,et al.Stabilization of unstable intertrochanteric fractures with the proximal femoral nail[J].Oper Orthop Traumatol,2013,25(1):63-83,quiz 83-84
[30]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):790-794