Effect of internal fixation with proximal femoral nail anti-rotation in patients with femoral intertrochanteric fractures
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摘要: 目的 观察近端防旋髓内钉(PFNA)内固定对股骨转子间骨折患者的影响。 方法 将206例股骨转子间骨折患者分为PFNA组(n=94)与近端解剖型锁定钢板(ALP)组(n=112)。根据倾向性匹配评分从以上2组各选取42例为PFNA亚组与ALP亚组。比较2组围术期指标、血清骨骼肌损伤指标［肌酸激酶(CK)、肌红蛋白(Myo)］、髋关节功能评分(Harris评分)及并发症发生率。 结果 PFNA亚组手术切口、手术时长、首次下床活动时间、住院时间、骨折愈合时间均短于ALP亚组,失血量少于ALP亚组,差异有统计学意义(P<0.05)。PFNA亚组术后2、24、72 h血清CK、Myo水平均低于ALP亚组,差异有统计学意义(P<0.05)。PFNA亚组术后1、3、6个月 Harris评分均高于ALP亚组,差异有统计学意义(P<0.05)。PFNA亚组术后3、6月Harris评分优良率均高于ALP亚组,差异有统计学意义(P<0.05); PFNA亚组术后并发症总发生率为4.76%,低于ALP亚组的23.81%,差异有统计学意义(P<0.05)。 结论 PFNA内固定治疗股骨转子间骨折,具有创伤小、骨折愈合及功能恢复快和并发症少等优势。Abstract: Objective To observe the effects of internal fixation with proximal femoral nail anti-rotation(PFNA)in patients with femoral intertrochanteric fractures. Methods A total of 206 patients with femoral intertrochanteric fractures were divided into PFNA group(n=94)and anatomic proximal femoral locking plate(ALP)group(n=112). According to the propensity score, 42 cases were separately selected from each of the above two groups as PFNA subgroup and ALP subgroup. The perioperative indexes, serum skeletal muscle injury indexes ［creatine kinase(CK), myoglobin(Myo)］, the Hip Function Score(Harris Score)and incidence of complications were compared between the two groups. Results The incision, operation duration, first ambulation time, hospital stay and fracture healing time of the PFNA subgroup were all significantly shorter than those of the ALP subgroup, and the blood loss was significantly less than that of the ALP subgroup(P<0.05). The levels of serum CK and Myo in the PFNA group at 2, 24 and 72 h after operation were significantly lower than those in the ALP subgroup(P<0.05). The Harris scores in the PFNA subgroup at 1month, 3 and 6 months after surgery were significantly higher than those in the ALP subgroup(P<0.05). The excellent rates of Harris score in PFNA subgroup at 3 and 6 months after operation were significantly higher than those in ALP subgroup(P<0.05). The incidence rate of total postoperative complications in the PFNA subgroup was significantly lower than that in the ALP subgroup(4.76% versus 23.81%, P<0.05). Conclusion PFNA internal fixation in the treatment of femoral intertrochanteric fractures has the advantages of less trauma, faster fracture healing as well as functional - recovery and fewer complications.
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