联合加压交锁髓内固定系统治疗Evans V型转子间骨折的价值分析
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摘要
目的探讨联合加压交锁髓内固定系统治疗Evans V型转子间骨折的价值。方法选取2013年1月至2016年10月本院收治的Evans V型转子间骨折患者96例为研究对象,采用投掷硬币法将其随机分为观察组(48例)和对照组(48例),观察组患者采用联合加压交锁髓内固定系统治疗,对照组患者采用单钉股骨近端髓内固定治疗。观察两组患者手术情况、术后恢复情况及并发症发生情况。结果与对照组比较,观察组患者手术时间显著延长[(54.73±13.58)分钟∶(43.28±11.74)分钟,P=0.000];术中出血量显著增加[(318.47±74.38)ml∶(256.79±66.81)ml,P=0.000];骨折愈合时间显著缩短[(101.31±10.21)天∶(113.06±11.28)天,P=0.000]。两组患者术前和术后6个月Harris评分比较均无显著差异(P>0.05)。观察组患者术后12个月Harris评分显著高于对照组[(81.65±5.49)分∶(78.69±4.83)分,P=0.006]。两组患者术后并发症发生率比较无显著差异(P>0.05)。结论联合加压交锁髓内固定系统可改善Evans V型转子间骨折患者术后功能康复。
Objective To investigate the value of interlocking intramedullary fixation system with integrated compression in the repair of Evans V intertrochanteric fractures. Method From January 2013 to October 2016, 96 patients with Evans V intertrochanteric fractures in our hospital were prospectively selected, they were randomly divided into observation group(n = 48) and control group(n = 48) by tossing coin method. Observation group patients adopted the interlocking intramedullary fixation system with integrated compression, while control group patients adopted the proximal femoral nail anti-rotation. The operation situation, postoperative recovery and complications of the two groups were compared. Result Compared with control group, the operation time of observation group was prolonged significantly [(54.73±13.58) min ∶(43.28±11.74) min, P = 0.000]; the amount of bleeding during the operation was increased [(318.47±74.38) ml ∶(256.79±66.81) ml, P = 0.000]; the fracture healing time was shorted significantly [(101.31±10.21) d ∶(113.06±11.28) d, P = 0.000]. There was no significant difference in the Harris scores between the two groups before and 6 months after operation(P > 0.05). The Harris score of observation group at 12 months after operation was significantly higher than that of control group [(81.65±5.49) ∶(78.69±4.83), P = 0.006]. There was no significant difference in postoperative complications between the two groups(P > 0.05). Conclusion Interlocking intramedullary fixation system with integrated compression improves the postoperative function recovery in patients with Evans V intertrochanteric fractures.
Objective To investigate the value of interlocking intramedullary fixation system with integrated compression in the repair of Evans V intertrochanteric fractures. Method From January 2013 to October 2016, 96 patients with Evans V intertrochanteric fractures in our hospital were prospectively selected, they were randomly divided into observation group(n = 48) and control group(n = 48) by tossing coin method. Observation group patients adopted the interlocking intramedullary fixation system with integrated compression, while control group patients adopted the proximal femoral nail anti-rotation. The operation situation, postoperative recovery and complications of the two groups were compared. Result Compared with control group, the operation time of observation group was prolonged significantly [(54.73±13.58) min ∶(43.28±11.74) min, P = 0.000]; the amount of bleeding during the operation was increased [(318.47±74.38) ml ∶(256.79±66.81) ml, P = 0.000]; the fracture healing time was shorted significantly [(101.31±10.21) d ∶(113.06±11.28) d, P = 0.000]. There was no significant difference in the Harris scores between the two groups before and 6 months after operation(P > 0.05). The Harris score of observation group at 12 months after operation was significantly higher than that of control group [(81.65±5.49) ∶(78.69±4.83), P = 0.006]. There was no significant difference in postoperative complications between the two groups(P > 0.05). Conclusion Interlocking intramedullary fixation system with integrated compression improves the postoperative function recovery in patients with Evans V intertrochanteric fractures.
引文
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[4]Elis J,Chechik O,Maman E,et al.Expandable proximal femoral nails versus 95 degrees dynamic condylar screwplates for the treatment of reverse oblique intertrochanteric fractures[J].Injury,2012,43(8):1313-1317.
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[7]Jonnes C,Sm S,Najimudeen S.TypeⅡIntertrochanteric Fractures:Proximal Femoral Nailing(PFN)Versus Dynamic Hip Screw(DHS)[J].Arch Bone Jt Surg,2016,4(1):23-28.
[8]Baldwin PC 3rd,Lavender RC,Sanders R,et al.Controversies in Intramedullary Fixation for Intertrochanteric Hip Fractures[J].J Orthop Trauma,2016,30(12):635-641.
[9]Reindl R,Harvey EJ,Berry GK,et al.Intramedullary Versus Extramedullary Fixation for Unstable Intertrochanteric Fractures:A Prospective Randomized Controlled Trial[J].J Bone Joint Surg Am,2015,97(23):1905-1912.
[10]梁昌详,郑晓青,昌耘冰,等.精确定位防旋髓内钉置入治疗股骨转子间骨折[J].中国组织工程研究,2014,18(17):2685-2690.
[11]Cai L,Wang T,Di L,et al.Comparison of intramedullary and extramedullary fixation of stable intertrochanteric fractures in the elderly:a prospective randomised controlled trial exploring hidden perioperative blood loss[J].BMC Musculoskelet Disord,2016,17(1):475.
[12]Turgut A,Kalenderer O,Gunaydin B,et al.Fixation of intertrochanteric femur fractures using Proximal Femoral Nail Antirotation(PFNA)in the lateral decubitus position without a traction table[J].Acta Orthop Traumatol Turc,2014,48(5):513-520.
[13]Cheng Q,Huang W,Gong X,et al.Minimally invasive percutaneous compression plating versus dynamic hip screw for intertr ochanteric fractures:a randomized control trial[J].Chin J Trau matol,2014,17(5):249-255.
[14]Serrano R,Blair JA,Watson DT,et al.Cephalomedullary nail fixation of intertrochanteric fractures:Are two proximal screws better than one?[J].J Orthop Trauma,2017,31(11):577-582.
[15]Santoni BG,Nayak AN,Cooper SA,et al.Comparison of Femoral Head Rotation and Varus Collapse Between a Single Lag Screw and Integrated Dual Screw Intertrochanteric Hip Fracture Fixation Device Using a Cadaveric Hemi-Pelvis Biomec hanical Model[J].J Orthop Trauma,2016,30(4):164-169.
[16]Hopp S,Wirbel R,Ojodu I,et al.Does the implant make the difference?-Prospective comparison of two different proximal femur nails[J].Acta Orthop Belg,2016,82(2):319-331.
[17]Kim JW,Kim TY,Ha YC,et al.Outcome of intertrochanteric fractures treated by intramedullary nail with two integrated lag screws:A study in Asian population[J].Indian J Orthop,2015,49(4):436-441.
[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 follow-up[J].BMC Musculoskelet Disord,2016,17:269.
[19]Su H,Sun K,Wang X.A randomized prospective comparison of Intertan and Gamma3 for treating unstable intertrochanteric fractures[J].Int J Clin Exp Med,2016,9(5):8640-8647.
[20]Zehir S,Sahin E,Zehir R.Comparison of clinical outcomes with three different intramedullary nailing devices in the treatment of unstable trochanteric fractures[J].Ulus Travma Acil Cerrahi Derg,2015,21(6):469-476.
[21]Yu W,Zhang X,Zhu X,et al.A retrospective analysis of the Inter Tan nail and proximal femoral nail anti-rotation-Asia in the treatment of unstable intertrochanteric femur fractures in the elderly[J].J Orthop Surg,2016,11:10.
[22]Seyhan M,Turkmen I,Unay K,et al.Do PFNA devices and Intertan nails both have the same effects in the treatment of trochanteric fractures?A prospective clinical study[J].J Orthop Sci,2015,20(6):1053-1061.
[23]Berger-Groch J,Rupprecht M,Schoepper S,et al.Five-Year Outcome Analysis of Intertrochanteric Femur Fractures:A Prospective Randomized Trial Comparing a 2-Screw and a Single-Screw Cephalomedullary Nail[J].J Orthop Trauma,2016,30(9):483-488.
[2]Kazemian GH,Emami M,Manafi A,et al.External Fixation vs.Skeletal Traction for Treatment of Intertrochanteric Fractures in the Elderly[J].Trauma Mon,2016,21(1):15477-15483.
[3]Yoo JI,Ha YC,Lim JY,et al.Early Rehabilitation in Elderly after Arthroplasty versus Internal Fixation for Unstable Intertrochanteric Fractures of Femur:Systematic Review and MetaAnalysis[J].J Korean Med Sci,2017,32(5):858-867.
[4]Elis J,Chechik O,Maman E,et al.Expandable proximal femoral nails versus 95 degrees dynamic condylar screwplates for the treatment of reverse oblique intertrochanteric fractures[J].Injury,2012,43(8):1313-1317.
[5]Hong JY,Suh SW,Park JH,et al.Comparison of soft-tissue serum markers in stable intertrochanteric fracture:dynamic hip screw versus proximal femoral nail-A preliminary study[J].Injury,2011,42(2):204-208.
[6]Kumar S,Chadha GN.Dynamic hip screw fixation of intertrochanteric fractures without using traction table[J].Acta Orthop Belg,2016,82(2):346-350.
[7]Jonnes C,Sm S,Najimudeen S.TypeⅡIntertrochanteric Fractures:Proximal Femoral Nailing(PFN)Versus Dynamic Hip Screw(DHS)[J].Arch Bone Jt Surg,2016,4(1):23-28.
[8]Baldwin PC 3rd,Lavender RC,Sanders R,et al.Controversies in Intramedullary Fixation for Intertrochanteric Hip Fractures[J].J Orthop Trauma,2016,30(12):635-641.
[9]Reindl R,Harvey EJ,Berry GK,et al.Intramedullary Versus Extramedullary Fixation for Unstable Intertrochanteric Fractures:A Prospective Randomized Controlled Trial[J].J Bone Joint Surg Am,2015,97(23):1905-1912.
[10]梁昌详,郑晓青,昌耘冰,等.精确定位防旋髓内钉置入治疗股骨转子间骨折[J].中国组织工程研究,2014,18(17):2685-2690.
[11]Cai L,Wang T,Di L,et al.Comparison of intramedullary and extramedullary fixation of stable intertrochanteric fractures in the elderly:a prospective randomised controlled trial exploring hidden perioperative blood loss[J].BMC Musculoskelet Disord,2016,17(1):475.
[12]Turgut A,Kalenderer O,Gunaydin B,et al.Fixation of intertrochanteric femur fractures using Proximal Femoral Nail Antirotation(PFNA)in the lateral decubitus position without a traction table[J].Acta Orthop Traumatol Turc,2014,48(5):513-520.
[13]Cheng Q,Huang W,Gong X,et al.Minimally invasive percutaneous compression plating versus dynamic hip screw for intertr ochanteric fractures:a randomized control trial[J].Chin J Trau matol,2014,17(5):249-255.
[14]Serrano R,Blair JA,Watson DT,et al.Cephalomedullary nail fixation of intertrochanteric fractures:Are two proximal screws better than one?[J].J Orthop Trauma,2017,31(11):577-582.
[15]Santoni BG,Nayak AN,Cooper SA,et al.Comparison of Femoral Head Rotation and Varus Collapse Between a Single Lag Screw and Integrated Dual Screw Intertrochanteric Hip Fracture Fixation Device Using a Cadaveric Hemi-Pelvis Biomec hanical Model[J].J Orthop Trauma,2016,30(4):164-169.
[16]Hopp S,Wirbel R,Ojodu I,et al.Does the implant make the difference?-Prospective comparison of two different proximal femur nails[J].Acta Orthop Belg,2016,82(2):319-331.
[17]Kim JW,Kim TY,Ha YC,et al.Outcome of intertrochanteric fractures treated by intramedullary nail with two integrated lag screws:A study in Asian population[J].Indian J Orthop,2015,49(4):436-441.
[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 follow-up[J].BMC Musculoskelet Disord,2016,17:269.
[19]Su H,Sun K,Wang X.A randomized prospective comparison of Intertan and Gamma3 for treating unstable intertrochanteric fractures[J].Int J Clin Exp Med,2016,9(5):8640-8647.
[20]Zehir S,Sahin E,Zehir R.Comparison of clinical outcomes with three different intramedullary nailing devices in the treatment of unstable trochanteric fractures[J].Ulus Travma Acil Cerrahi Derg,2015,21(6):469-476.
[21]Yu W,Zhang X,Zhu X,et al.A retrospective analysis of the Inter Tan nail and proximal femoral nail anti-rotation-Asia in the treatment of unstable intertrochanteric femur fractures in the elderly[J].J Orthop Surg,2016,11:10.
[22]Seyhan M,Turkmen I,Unay K,et al.Do PFNA devices and Intertan nails both have the same effects in the treatment of trochanteric fractures?A prospective clinical study[J].J Orthop Sci,2015,20(6):1053-1061.
[23]Berger-Groch J,Rupprecht M,Schoepper S,et al.Five-Year Outcome Analysis of Intertrochanteric Femur Fractures:A Prospective Randomized Trial Comparing a 2-Screw and a Single-Screw Cephalomedullary Nail[J].J Orthop Trauma,2016,30(9):483-488.