股骨近端防旋髓内钉与股骨近端解剖型锁定钢板治疗老年不稳定型股骨转子间骨折的效果比较(1)
[摘要] 目的 比较股骨近端防旋髓内钉(PFNA)与股骨近端解剖型锁定钢板治疗老年不稳定型股骨转子间骨折的临床效果。 方法 选择2012年3月～2016年3月在宝鸡市中医医院治疗的老年不稳定型股骨转子间骨折患者94例，采用随机数字表法分为两组，每组各47例。A组采用股骨近端解剖型锁定钢板治疗，B组患者采用PFNA治疗。比较两组手术情况；并于术后1年随访，比较两组并发症发生情况、髋关节功能和骨折愈合情况。 结果 手术均顺利完成且无死亡病例。B组切口长度、手术时间、术中出血量、术中引血量、住院天数、术后负重时间均低于A组，差异有统计学意义(P < 0.05)。X线片显示，A组术后愈合较慢，且钢板较易断板；B组愈合良好，正位片显示患侧骨折无移位。B组术后并发症发生率低于A组，B组临床效果优于A组，差异有统计学意义(P < 0.05)。 结论 PFNA治疗老年不稳定型股骨转子间骨折具有恢复快、手术操作简单、稳定性强、并发症少等优点，值得临床推广应用。
[关键词] 股骨近端防旋髓内钉；股骨近端解剖型锁定钢板；不稳定型股骨转子间骨折；老年人
[中图分类号] R683 [文献标识码] A [文章编号] 1673-7210(2017)07(c)-0090-04
[Abstract] Objective To compare the effect of proximal femoral nail anti-rotation (PFNA) and proximal femoral anatomic locking plate in the treatment of intertrochanteric fracture in the elderly. Methods From March 2012 to March 2016， 94 elderly patients with unstable type femur fractures for treatment in Baoji Hospital of Traditional Chinese Medicine were selected and divided into two groups by random number table， with 47 cases in each group. The patients in group A were treated with proximal femoral anatomic lock plate， and the patients in group B were treated with bone proximal nailing. The operation situation in the two groups were compared. After 12 months after operation， the occurrence of complications， hip joint function and fracture healing in the two groups were compared. Results The operation was completed without death. The incision length， operative time， intraoperative blood loss， intraoperative blood volume， postoperative hospitalization days and the load time in group B were lower than those in group A， with statistically significant difference (P < 0.05). The X-ray showed that the group A healed slowly after surgery and the plate was more easily broken， while the group B was well healed， and there was no displacement of the lateral fracture. The postoperative complication of group B was lower than that in the group A， and the overall optimal rate of clinical effect in the group B was better than that in the group A (P < 0.05). Conclusion PFNA treatment for the elderly with intertrochanteric fracture has the advantages of quick recovery， simple operation， strong stability and few complications， which is worthy of clinical application.
[Key words] Proximal femoral nail anti-rotation； Proximal femoral anatomic locking plate； Intertrochanteric fracture； The elderly
股骨轉子间骨折是临床最常见的髋部骨折之一，好发于老年人，一般发病部位为髋关节囊线以外至小转子下方区域内，约占髋部骨折的1/3，常为跌倒后骸部着地所引起，又因老年人常伴有骨质疏松，骨代谢异常，即使非暴力导致，也会使得其遇低能量损伤即发生骨折，并呈现不稳定粉碎移位等特征[1]。另外，老年人常会患有其他各种内科或系统性疾病，身体承受性弱，股骨上端难以抵抗骸部着地时产生的应力而出现转子间骨折，加之保守治疗的并发症较多，相应地发生死亡的比率明显升高。目前我国社会老龄化现象严重较为严重，日益攀升的转子间骨折发生率已经成为阻碍老年人身体健康的重大问题。因老年不稳定型股骨转子间骨折内固定较为困难，且患者会因长期卧床而产生一系列并发症，故而，传统的内固定方法应用较少。目前多主张手术治疗，但手术方法较多，尚无统一定论。本研究为探讨治疗老年不稳定型股骨转子间骨折的方法，比较股骨近端防旋髓内钉(PFNA)和股骨近端解剖型锁定钢板治疗的效果，现将研究内容报道如下：, 百拇医药(谢晓敏 陈宇飞 周晓庆 贾斌 苟波)
[关键词] 股骨近端防旋髓内钉；股骨近端解剖型锁定钢板；不稳定型股骨转子间骨折；老年人
[中图分类号] R683 [文献标识码] A [文章编号] 1673-7210(2017)07(c)-0090-04
[Abstract] Objective To compare the effect of proximal femoral nail anti-rotation (PFNA) and proximal femoral anatomic locking plate in the treatment of intertrochanteric fracture in the elderly. Methods From March 2012 to March 2016， 94 elderly patients with unstable type femur fractures for treatment in Baoji Hospital of Traditional Chinese Medicine were selected and divided into two groups by random number table， with 47 cases in each group. The patients in group A were treated with proximal femoral anatomic lock plate， and the patients in group B were treated with bone proximal nailing. The operation situation in the two groups were compared. After 12 months after operation， the occurrence of complications， hip joint function and fracture healing in the two groups were compared. Results The operation was completed without death. The incision length， operative time， intraoperative blood loss， intraoperative blood volume， postoperative hospitalization days and the load time in group B were lower than those in group A， with statistically significant difference (P < 0.05). The X-ray showed that the group A healed slowly after surgery and the plate was more easily broken， while the group B was well healed， and there was no displacement of the lateral fracture. The postoperative complication of group B was lower than that in the group A， and the overall optimal rate of clinical effect in the group B was better than that in the group A (P < 0.05). Conclusion PFNA treatment for the elderly with intertrochanteric fracture has the advantages of quick recovery， simple operation， strong stability and few complications， which is worthy of clinical application.
[Key words] Proximal femoral nail anti-rotation； Proximal femoral anatomic locking plate； Intertrochanteric fracture； The elderly
股骨轉子间骨折是临床最常见的髋部骨折之一，好发于老年人，一般发病部位为髋关节囊线以外至小转子下方区域内，约占髋部骨折的1/3，常为跌倒后骸部着地所引起，又因老年人常伴有骨质疏松，骨代谢异常，即使非暴力导致，也会使得其遇低能量损伤即发生骨折，并呈现不稳定粉碎移位等特征[1]。另外，老年人常会患有其他各种内科或系统性疾病，身体承受性弱，股骨上端难以抵抗骸部着地时产生的应力而出现转子间骨折，加之保守治疗的并发症较多，相应地发生死亡的比率明显升高。目前我国社会老龄化现象严重较为严重，日益攀升的转子间骨折发生率已经成为阻碍老年人身体健康的重大问题。因老年不稳定型股骨转子间骨折内固定较为困难，且患者会因长期卧床而产生一系列并发症，故而，传统的内固定方法应用较少。目前多主张手术治疗，但手术方法较多，尚无统一定论。本研究为探讨治疗老年不稳定型股骨转子间骨折的方法，比较股骨近端防旋髓内钉(PFNA)和股骨近端解剖型锁定钢板治疗的效果，现将研究内容报道如下：, 百拇医药(谢晓敏 陈宇飞 周晓庆 贾斌 苟波)