不同内固定手术方案对改良Evans Ⅰ-Ⅲ型改良Evans Ⅰ-Ⅲ型股骨粗隆间骨折患者疗效及安全性的影响
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摘要
目的探讨GAMMA-3钉内固定术和PFNA内固定术对改良Evans Ⅰ-Ⅲ型股骨粗隆间骨折患者疗效及安全性的影响。方法选取我院2016年1月～2017年6月收治改良Evans Ⅰ-Ⅲ型股骨粗隆间骨折患者共90例,以随机数字表法分为GAMMA-3钉组(45例)和PFNA组(45例),分别采用GAMMA-3钉和PFNA内固定术治疗,比较两组术中术后临床指标水平、术后Harris评分优良率,术后随访1、3、6及12个月Harris评分,术后并发症发生率。结果 PFNA组手术用时、手术失血量及术中辐射次数均显著少于GAMMA-3钉组(P<0.05);两组切口长度和骨折愈合用时比较差异无显著性(P>0.05);两组术后Harris评分优良率和术后随访Harris评分比较差异无显著性(P>0.05);同时两组术后骨折内移、颈干角过大及外侧壁破裂发生率比较差异无显著性(P>0.05)。结论 GAMMA-3钉内固定术和PFNA内固定术治疗改良Evans Ⅰ-Ⅲ型股骨粗隆间骨折在促进髋关节功能恢复和手术安全性方面较为接近;其中PFNA内固定术具有操作简便、微创及术中辐射少等优势,更具临床应用价值。
Objective To compare the influence of GAMMA-3 nail internal fixation operation and PFNA internal fixation operation on clinical effects and safety of patients with femoral intertrochanteric fractures for modified Evans Ⅰ-Ⅲ type. Methods 90 elderly patients with femoral intertrochanteric fractures for modified Evans Ⅰ-Ⅲ type were chosen in the period from January 2016 to June 2017 in our hospital and randomly divided into both group including GAMMA-3 nail group(45 patients) with GAMMA-3 nail internal fixation operation and PFNA group(45 patients) with PFNA internal fixation operation; and the clinical index in and after operation, the excellent and good rate of Harris scores after operation, the postoperative Harris score with follow-up and the complications incidence after operation of both groups were compared. Results The operation time, the intraoperative blood loss volume and the radiation times in operation of PFNA group were significantly less than GAMMA-3 nail group(P<0.05).There was no significant difference in the excellent and good rate of Harris scores after operation and postoperative Harris score with follow-up between 2 groups(P>0.05). There was no significant difference in the complications incidence after operation between 2 groups(P>0.05). Conclusion GAMMA-3 nail internal fixation operation and PFNA internal fixation operation in the treatment of patients with femoral intertrochanteric fractures for modified Evans Ⅰ-Ⅲ type possess the same clinical recovery effects of hip function and safety; but PFNA operation application can efficiently reduce the operation difficulty, decrease the iatrogenic trauma degree and radiation times.
Objective To compare the influence of GAMMA-3 nail internal fixation operation and PFNA internal fixation operation on clinical effects and safety of patients with femoral intertrochanteric fractures for modified Evans Ⅰ-Ⅲ type. Methods 90 elderly patients with femoral intertrochanteric fractures for modified Evans Ⅰ-Ⅲ type were chosen in the period from January 2016 to June 2017 in our hospital and randomly divided into both group including GAMMA-3 nail group(45 patients) with GAMMA-3 nail internal fixation operation and PFNA group(45 patients) with PFNA internal fixation operation; and the clinical index in and after operation, the excellent and good rate of Harris scores after operation, the postoperative Harris score with follow-up and the complications incidence after operation of both groups were compared. Results The operation time, the intraoperative blood loss volume and the radiation times in operation of PFNA group were significantly less than GAMMA-3 nail group(P<0.05).There was no significant difference in the excellent and good rate of Harris scores after operation and postoperative Harris score with follow-up between 2 groups(P>0.05). There was no significant difference in the complications incidence after operation between 2 groups(P>0.05). Conclusion GAMMA-3 nail internal fixation operation and PFNA internal fixation operation in the treatment of patients with femoral intertrochanteric fractures for modified Evans Ⅰ-Ⅲ type possess the same clinical recovery effects of hip function and safety; but PFNA operation application can efficiently reduce the operation difficulty, decrease the iatrogenic trauma degree and radiation times.
引文
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[2]Marmor M,Elliott IS,Marshall ST,et al.Biomechanical comparison of long,short,and extended-short nail construct for osteoporosis femoral intertrochanteric fractures[J].Injury,2015,46(6):963-969.
[3]Yang ZB,Wu PH,Wong PK,et al.Better Prognosis of Senile Patients with Intertrochanteric Femoral Fracture by Treatment with Open Reduction Internal Fixation than by Hip Arthroplasty[J].JInvest Surg,2017,19(7):1-7.
[4]胥少汀,葛宝丰,徐印坎.实用骨科学[M].4版.北京:人民军医出版社,2012:1522-1523.
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[7]Grosso MJ,Lipman J,Bostrom MP.Coupling device and distal femoral replacement for periprosthetic supracondylar femur fractures with anipsilateral total knee and hip replacement[J].HSSJ,2014,10(1):68-72.
[8]Zhang L,Shen J,Chen S,et al.Treatment of unstable intertrochanteric femoral fractures with locking gamma nail(LGN):A Retrospective Cohort Study[J].Int J Surg,2016,26(3):12-17.
[9]Haq RU,Manhas V,Pankaj A,et al.Proximal femoral nails compared with reverse distal femoral locking plates in intertrochanteric fractures with a compromised lateral wall:a randomised controlled trial[J].Int Orthop,2014,38(7):1443-1449.
[10]Sahin EK,Imerci A,Kinik H,et al.Comparison of proximal femoral nail antirotation(PFNA)with AO dynamic condylar screws(DCS)for thetreatment for unstable peritrochanteric femoral fractures[J].Eur J Orthop Surg Traumatol,2014,24(3):347-352.
[11]Gilat R,Lubovsky O,Atoun E,et al.Proximal Femoral Shortening After Cephalomedullary Nail Insertion for Intertrochanteric Fractures[J].J Orthopaedic Trauma,2017,31(6):311-317.
[12]Yu W,Zhang X,Zhu X,et al.Proximal femoral nails anti-rotation versus dynamic hip screws for treatment of stable intertrochanteric femur fractures:an outcome analyses with a minimum 4 years of follow-up[J].BMC Musculoskeletal Disorder,2016,17(1):222-230.
[13]Hu S J,Chang SM,Ma Z,et al.PFNA-II protrusion over the greater trochanter in the Asian population used in proximal femoral fractures[J].Indian J Orthop,2016,50(6):641-646.
[14]Hierholzer C,Glowalla C,Herrler M,et al.Reamed intramedullary exchange nailing:treatment of choice of aseptic femoral shaft nonunion[J].J Orthop Surg Res,2014,15(9):88-94.
[15]Zeng X,Nan Z,Dan Z,et al.Proximal femoral nail antirotation versus dynamic hip screw fixation for treatment of osteoporotic type 31-A1 intertrochanteric femoral fractures in elderly patients[J].J Int Med Res,2017,45(3):1109-1123.
[16]Zhang H,Zeng X,Zhang N,et al.INTERTAN nail versus proximal femoral nail antirotation-Asia for intertrochanteric femur fractures in elderly patients with primary osteoporosis[J].J Int Med Res,2017,45(4):300060517710584.
[17]Hong JB,Dan Y,Ouyang L,et al.Biomechanical study on different lengths of PFNA fixation for unstable intertrochanteric Interact,2017,17(4):299-302.
[2]Marmor M,Elliott IS,Marshall ST,et al.Biomechanical comparison of long,short,and extended-short nail construct for osteoporosis femoral intertrochanteric fractures[J].Injury,2015,46(6):963-969.
[3]Yang ZB,Wu PH,Wong PK,et al.Better Prognosis of Senile Patients with Intertrochanteric Femoral Fracture by Treatment with Open Reduction Internal Fixation than by Hip Arthroplasty[J].JInvest Surg,2017,19(7):1-7.
[4]胥少汀,葛宝丰,徐印坎.实用骨科学[M].4版.北京:人民军医出版社,2012:1522-1523.
[5]王亦璁,姜保国.骨与关节损伤[M].5版.北京:人民卫生出版社,2012:399-400.
[6]Ronga M,Bonzini D,Valoroso M,et al.Blood loss in trochanteric fractures:multivariate analysis comparing dynamic hip screw and Gamma nail[J].Injury,2017,48(Suppl 3):S44-S47.
[7]Grosso MJ,Lipman J,Bostrom MP.Coupling device and distal femoral replacement for periprosthetic supracondylar femur fractures with anipsilateral total knee and hip replacement[J].HSSJ,2014,10(1):68-72.
[8]Zhang L,Shen J,Chen S,et al.Treatment of unstable intertrochanteric femoral fractures with locking gamma nail(LGN):A Retrospective Cohort Study[J].Int J Surg,2016,26(3):12-17.
[9]Haq RU,Manhas V,Pankaj A,et al.Proximal femoral nails compared with reverse distal femoral locking plates in intertrochanteric fractures with a compromised lateral wall:a randomised controlled trial[J].Int Orthop,2014,38(7):1443-1449.
[10]Sahin EK,Imerci A,Kinik H,et al.Comparison of proximal femoral nail antirotation(PFNA)with AO dynamic condylar screws(DCS)for thetreatment for unstable peritrochanteric femoral fractures[J].Eur J Orthop Surg Traumatol,2014,24(3):347-352.
[11]Gilat R,Lubovsky O,Atoun E,et al.Proximal Femoral Shortening After Cephalomedullary Nail Insertion for Intertrochanteric Fractures[J].J Orthopaedic Trauma,2017,31(6):311-317.
[12]Yu W,Zhang X,Zhu X,et al.Proximal femoral nails anti-rotation versus dynamic hip screws for treatment of stable intertrochanteric femur fractures:an outcome analyses with a minimum 4 years of follow-up[J].BMC Musculoskeletal Disorder,2016,17(1):222-230.
[13]Hu S J,Chang SM,Ma Z,et al.PFNA-II protrusion over the greater trochanter in the Asian population used in proximal femoral fractures[J].Indian J Orthop,2016,50(6):641-646.
[14]Hierholzer C,Glowalla C,Herrler M,et al.Reamed intramedullary exchange nailing:treatment of choice of aseptic femoral shaft nonunion[J].J Orthop Surg Res,2014,15(9):88-94.
[15]Zeng X,Nan Z,Dan Z,et al.Proximal femoral nail antirotation versus dynamic hip screw fixation for treatment of osteoporotic type 31-A1 intertrochanteric femoral fractures in elderly patients[J].J Int Med Res,2017,45(3):1109-1123.
[16]Zhang H,Zeng X,Zhang N,et al.INTERTAN nail versus proximal femoral nail antirotation-Asia for intertrochanteric femur fractures in elderly patients with primary osteoporosis[J].J Int Med Res,2017,45(4):300060517710584.
[17]Hong JB,Dan Y,Ouyang L,et al.Biomechanical study on different lengths of PFNA fixation for unstable intertrochanteric Interact,2017,17(4):299-302.