微创PFNA-Ⅱ内固定术治疗老年不稳定型股骨粗隆间骨折的疗效观察
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摘要
目的探讨微创PFNA-Ⅱ内固定术治疗老年不稳定型股骨粗隆间骨折的疗效。方法选择2015年11月至2017年5月普宁市人民医院收治的60例老年不稳定型股骨粗隆间骨折患者,按照手术方式不同分为2组,以微创PFNA-Ⅱ内固定术治疗的患者为内固定组,以人工股骨头置换术治疗的患者为人工关节组,每组30例。对比2组患者手术情况、疗效、并发症发生情况及功能恢复情况。结果内固定组手术情况优于人工关节组,差异具有统计学意义(P <0. 05);内固定组治疗总有效率为96. 67%,人工关节组为90. 00%,差异无统计学意义(P> 0. 05);内固定组并发症发生率为13. 33%,人工关节组为46. 67%,差异具有统计学意义(P <0. 05); 2组患者治疗后3个月Harris评分比较差异有统计学意义(P <0. 05)。结论微创PFNA-Ⅱ内固定术治疗老年不稳定型股骨粗隆间骨折能够帮助患者提高术后恢复效果,降低并发症发生率。
Objective To investigate the clinical effect of PFNA-II internal fixation in the treatment of unstable intertrochanteric fractures in the elder patients. Methods A total of 60 senile patients with unstable femoral intertrochanteric fracture in Puning people's hospital from November 2015 to May 2017 were selected and divided into two groups according to different surgical methods. Patients received PFNA-Ⅱ internal fixation were regarded as internal fixation group,while patients received hemiarthroplasty treatment were regarded as the artificial joint group,with 30 cases in each group. The curative effect,the incidence of complications and functional recovery of the two groups were compared. Results The operation situation of internal fixation group was better than that of the artificial joint group,with statistically significant differences( P < 0. 05). The total effectiveness rate of internal fixation group was 96. 67%,while 90% in the artificial joint group,the difference was no significant( P > 0. 05). The incidence of complications in internal fixation group and the artificial joint group were 13. 33%and 46. 67% respectively,with statistically significant differences( P < 0. 05). The Harris score between two groups in 3 months postoperation had statistically significant difference( P < 0. 05). Conclusion Minimally invasive PFNA-Ⅱ internal fixation can improve postoperative recovery effect and reduce postoperative complication for the elderly with unstable intertrochanteric fractures.
Objective To investigate the clinical effect of PFNA-II internal fixation in the treatment of unstable intertrochanteric fractures in the elder patients. Methods A total of 60 senile patients with unstable femoral intertrochanteric fracture in Puning people's hospital from November 2015 to May 2017 were selected and divided into two groups according to different surgical methods. Patients received PFNA-Ⅱ internal fixation were regarded as internal fixation group,while patients received hemiarthroplasty treatment were regarded as the artificial joint group,with 30 cases in each group. The curative effect,the incidence of complications and functional recovery of the two groups were compared. Results The operation situation of internal fixation group was better than that of the artificial joint group,with statistically significant differences( P < 0. 05). The total effectiveness rate of internal fixation group was 96. 67%,while 90% in the artificial joint group,the difference was no significant( P > 0. 05). The incidence of complications in internal fixation group and the artificial joint group were 13. 33%and 46. 67% respectively,with statistically significant differences( P < 0. 05). The Harris score between two groups in 3 months postoperation had statistically significant difference( P < 0. 05). Conclusion Minimally invasive PFNA-Ⅱ internal fixation can improve postoperative recovery effect and reduce postoperative complication for the elderly with unstable intertrochanteric fractures.
引文
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[14]秦宏敏,殷光义,邹拥军,等. PFNAⅡ治疗老年AO各型股骨粗隆间骨折的疗效分析[J].中国矫形外科杂志,2014,22(22):2017-2023. doi:10. 3977/j. issn. 1005-8478. 2014. 22. 01.
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[16]石波,王军,康斌,等. PFNA治疗老年股骨粗隆间骨折的回顾性分析[J].中国骨与关节损伤杂志,2010,25(10):909.
[17]Li J,Cheng L,Jing J,et al. The Asia proximal femoral nail antirotation versus the standard proximal femoralantirotation nail for unstable intertrochanteric fractures in elderly Chinese patients[J]. Orthop Traumatol Surg Res,2015,101(2):143-146. doi:10. 1016/j. otsr.2014. 12. 011.
[18]范永前,梁承伟,林伟龙,等.股骨粗隆间骨折复位过程中旋转控制策略[J].中国骨与关节损伤杂志,2012,27(12):1081-1083.
[19]Tao YL,Ma Z,Chang SM. Does PFNAⅡavoid lateral cortex impingement for unstable peritrochanteric fractures?[J]. Clin Orthop Relat Res,2013,471(4):1393-1394. doi:10. 1007/s11999-013-2793-1.
[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] Zehir S,Zehir R,Zehir S,et al. Proximal femoral nail antirotation against dynamic hip screw for unstable trochanteric fractures:a prospective randomized comparison[J]. Eur J Trauma Emerg Surg,2015,41(4):393-400. doi:10. 1007/s00068-014-0463-y.
[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):e288-294. doi:10. 3928/01477447-20130222-16.
[23] Chang SM,Song DL,Ma Z,et al. Mismatch of the short straight cephalome-dullary nail(PFNA-Ⅱ)with the anterior bow of the femur in an asian population[J]. J Orthop Trauma,2014,28(1):17-22.doi:10. 1097/BOT. 0000000000000022.
[24]于永杰,杨东,焦兆德,等.股骨近端万向锁定钢板治疗老年股骨粗隆间骨折的效果观察[J].山东医药,2016,56(17):96-97.doi:10. 3969/j. issn. 1002-266X. 2016. 17. 036.
[25]Roberts KC,Brox WT,Jevsevar DS,et al. Management of hip fractures in the elderly[J]. J Am Acad Orthop Surg,2015,23(2):131-137.
[2]栾斐宇,王文波.高龄股骨粗隆间骨折手术治疗进展[J].医学综述,2017,23(17):3441-3444. doi:10. 3969/j. issn. 1006-2084.2017. 17. 025.
[3]Senohradski K,Markovic-Denic L,Lesic A,et al. Trends in the incidence of hip fractures[J]. Osteoporosis International,2013,24(5):1759-1763.
[4]Bonnevialle P,Saragaglia D,Ehlinger M,et al. Trochanteric locking nail versus arthroplasty in unstable intertrochanteric fracture in patients aged over 75 years[J]. Orthop Trauma Surg Res,2011,97(6):S95-100. doi:10. 1016/j. otsr. 2011. 06. 009.
[5]许庆利,范勇,王兴元,等. PFNA与人工股骨头置换术治疗老年不稳定型股骨粗隆间骨折的临床疗效分析[J]. 2017,19(2):106-110. doi:10. 3969/j. issn. 1009-4237. 2017. 02. 007.
[6]李中檀.人工股骨头置换与PFNA治疗高龄不稳定型股骨粗隆间骨折的疗效对比分析[J].河北医学,2018,24(2):188-192. doi:10.3969/j. issn. 1006-6233. 2018. 02. 003.
[7]龚伟华,曾一鸣,唐坚,等.髋部骨折的发生与股骨近端三维几何解剖形态的相关性研究[J].医用生物力学,2013,28(1):109-114. doi:10. 16156/j. 1004-7220. 2013. 01. 010.
[8]易先宏,陈红卫,潘骏.动力髋部螺钉与股骨近端髓内钉固定不稳定股骨转子间骨折的生物力学比较[J].医用生物力学,2013,28(2):235-239. doi:10. 16156/j. 1004-7220. 2013. 02. 007.
[9]周述清.防旋型股骨近端髓内钉(PFNA-Ⅱ)置入与人工髋关节置换治疗高龄转子间骨折的疗效观察[D].重庆:重庆医科大学,2015.
[10]王卫东,王裕祥,王永虎,等.不同手术方法治疗老年股骨粗隆间骨折临床特点对比[J].中国老年学杂志,2015,35(18):5239-5241. doi:10. 3969/j. issn. 1005-9202. 2015. 18. 096.
[11]周跃江,包洪卫,王海红,等.小切口股骨近端防旋髓内钉治疗老年股骨粗隆间骨折[J].中国微创外科杂志,2016,16(4):344-346. doi:10. 3969/j. issn. 1009-6604. 2016. 04. 015.
[12]杨飞,韩启明,杨凤明,等.老年股骨粗隆间骨折微创INTERTAN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):897-901. doi:10. 3977/j. issn. 1005-8478. 2015.10. 07.
[13]丁庆丰,吴贵忠,季承,等. PFNA-Ⅱ与DHS治疗老年骨质疏松性股骨转子间骨折的临床疗效比较[J].影像研究与医学应用,2017,1(13):255-256.
[14]秦宏敏,殷光义,邹拥军,等. PFNAⅡ治疗老年AO各型股骨粗隆间骨折的疗效分析[J].中国矫形外科杂志,2014,22(22):2017-2023. doi:10. 3977/j. issn. 1005-8478. 2014. 22. 01.
[15]王超. InterTan治疗成人股骨粗隆间骨折的临床疗效观察[D].济南:山东中医药大学,2015.
[16]石波,王军,康斌,等. PFNA治疗老年股骨粗隆间骨折的回顾性分析[J].中国骨与关节损伤杂志,2010,25(10):909.
[17]Li J,Cheng L,Jing J,et al. The Asia proximal femoral nail antirotation versus the standard proximal femoralantirotation nail for unstable intertrochanteric fractures in elderly Chinese patients[J]. Orthop Traumatol Surg Res,2015,101(2):143-146. doi:10. 1016/j. otsr.2014. 12. 011.
[18]范永前,梁承伟,林伟龙,等.股骨粗隆间骨折复位过程中旋转控制策略[J].中国骨与关节损伤杂志,2012,27(12):1081-1083.
[19]Tao YL,Ma Z,Chang SM. Does PFNAⅡavoid lateral cortex impingement for unstable peritrochanteric fractures?[J]. Clin Orthop Relat Res,2013,471(4):1393-1394. doi:10. 1007/s11999-013-2793-1.
[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] Zehir S,Zehir R,Zehir S,et al. Proximal femoral nail antirotation against dynamic hip screw for unstable trochanteric fractures:a prospective randomized comparison[J]. Eur J Trauma Emerg Surg,2015,41(4):393-400. doi:10. 1007/s00068-014-0463-y.
[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):e288-294. doi:10. 3928/01477447-20130222-16.
[23] Chang SM,Song DL,Ma Z,et al. Mismatch of the short straight cephalome-dullary nail(PFNA-Ⅱ)with the anterior bow of the femur in an asian population[J]. J Orthop Trauma,2014,28(1):17-22.doi:10. 1097/BOT. 0000000000000022.
[24]于永杰,杨东,焦兆德,等.股骨近端万向锁定钢板治疗老年股骨粗隆间骨折的效果观察[J].山东医药,2016,56(17):96-97.doi:10. 3969/j. issn. 1002-266X. 2016. 17. 036.
[25]Roberts KC,Brox WT,Jevsevar DS,et al. Management of hip fractures in the elderly[J]. J Am Acad Orthop Surg,2015,23(2):131-137.