解剖型髓内钉和股骨近端防旋髓内钉治疗老年股骨转子间骨折的疗效比较

doi:10.19723/j.issn.1671-167X.2019.02.016

摘要/Abstract

摘要：

目的: 比较股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)与解剖型髓内钉(zimmer natural nail,ZNN)治疗老年股骨转子间骨折的临床疗效,为临床选择围手术期的处理方式提供数据支撑。方法: 回顾性分析北京大学人民医院创伤骨科2016 年5 月至2017 年5 月收治且获得完整随访的59例老年股骨转子间骨折患者资料,其中PFNA组28 例,ZNN组31 例。分析比较两组手术时间、术中出血量、骨折愈合时间、术后内固定并发症、术后尖顶距和末次随访髋关节评分。结果: 平均随访(10.8±4.0)个月(6~19 个月), PFNA组患者的手术时间为(62.7±14.2) min,术中出血量为(56.8±20.6) mL,骨折愈合时间为(4.6±0.8)个月,术后内固定并发症发生率为3.6%,术后尖顶距为(17.7±5.5) mm,末次随访髋关节评分为91.8±3.6。ZNN组手术时间为(73.6±18.3) min,术中出血量为(68.7±31.6) mL,骨折愈合时间为(4.5±0.7)个月,术后内固定并发症发生率为3.2%,术后尖顶距为(16.5±4.7) mm,末次随访髋关节评分为92.2±3.8。两组相比,PFNA组在手术时间方面较ZNN组短(P<0.05),而在其他评价指标,两组之间差异均无统计学意义(P>0.05)。结论: PFNA和ZNN内固定术都是治疗老年股骨转子间骨折的有效术式,PFNA的操作更简捷;ZNN的前弓设计可能更适合部分股骨前弓弧度较大的患者。

关键词: 股骨转子间骨折, 骨折固定术, 髓内钉, 老年人

Abstract:

Objective: To explore the effect of cephalomedullary nails for elderly intertrochanteric fractures: proximal femoral nail antirotation (PFNA) versus zimmer natural nail (ZNN) to provide the data support for clinical perioperative management.Methods: A retrospective study was used to analyze the clinical data of elderly intertrochanteric fractures cases which were treated with PFNA or ZNN fixation from May 2016 to May 2017. In the study, 59 cases were followed up completely, in which 28 cases accepted PFNA, and the other 31 cases accepted ZNN. The operation time, amount of bleeding, fracture healing time, postoperative complication, postoperative radiographic measurement (tip apex distance, TAD) and the last follow-up of hip function score were analyzed.Results: The patients were followed up for 6 to 19 months, with an average (10.8±4.0) months. In PFNA group, the operation time was (62.7±14.2) min, the amount of bleeding was (56.8±20.6) mL, the fracture healing time was (4.6±0.8) months, the postoperative complication was 3.6%, the TAD was (17.7±5.5) mm, and the last follow-up hip function score was 91.8±3.6. In ZNN group, the operation time was (73.6±18.3) min, the amount of bleeding was (68.7±31.6) mL, the fracture healing time was (4.5±0.7) months, the postoperative complication was 3.2%, the TAD was (16.5±4.7) mm, and the last follow-up hip function score was 92.2±3.8. The two groups of comparative experiments were carried out, the operation time of the PFNA group was less than that of the ZNN group (P<0.05). There was no significant difference in the amount of bleeding, fracture healing time, postoperative complication, TAD, postoperative hip score between the two groups (P>0.05).Conclusion: Although group ZNN had significant longer operation time than group PFNA, both implants were useful tools in the treatment of elderly intertrochanteric fractures. The operation of PFNA was simpler,while the design of the anterior bow of ZNN might be more suitable for the patients with a large femoral anterior bow.

Key words: Femoral intertrochanteric fractures, Fracture fixation, Intramedullary nail, The elderly

中图分类号:

R683

陈健,左才红,张财义,杨明,张培训. 解剖型髓内钉和股骨近端防旋髓内钉治疗老年股骨转子间骨折的疗效比较[J]. 北京大学学报（医学版）, 2019, 51(2): 283-287.

Jian CHEN,Cai-hong ZUO,Cai-yi ZHANG,Ming YANG,Pei-xun ZHANG. Comparison of the effects of two cephalomedullary nails (zimmer natural nail and proximal femoral nail antirotation) in treatment of elderly intertrochan teric fractures[J]. Journal of Peking University(Health Sciences), 2019, 51(2): 283-287.

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参考文献 22

[1]	Haidukewych GJ . Intertrochanteric fractures: ten tips to improve results[J]. J Bone Joint Surg Am, 2009,91(3):712-719.
[2]	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. doi: 10.5435/JAAOS-D-14-00432
[3]	Jensen JS . Classification of trochanteric fractures[J]. Acta Orthop Scand, 1980,51(5):803-810. doi: 10.3109/17453678008990877
[4]	杨明, 张晓萌, 张培训 , 等. 经皮导入导针结合纯侧位透视简化股骨近端防旋髓内钉操作[J]. 北京大学学报(医学版), 2015,47(2):258-262. doi: 10.3969/j.issn.1671-167X.2015.02.013
[5]	Stern R, Lübbeke A, Suva D , et al. Prospective randomised study comparing screw versus helical blade in the treatment of low-energy trochanteric fractures[J]. Int Orthop, 2011,35(12):1855-1861. doi: 10.1007/s00264-011-1232-8
[6]	Harris WH . Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplast. An end-result study using a new method of result evaluation[J]. J Bone Joint Surg Am, 1969,51(4):737-755. doi: 10.2106/00004623-196951040-00012
[7]	Tucker A, Donnelly KJ, McDonald S , et al. The changing face of fractures of the hip in Northern Ireland: a 15-year review[J]. Bone Joint J, 2017,99B(9):1223-1231.
[8]	张树, 张继源, 杨杜明 , 等. 矢状位不稳定转子间骨折的形态特征和复位技术[J]. 北京大学学报(医学版), 2017,49(2):236-241.
[9]	Chatterton BD, Moores TS, Ahmad S , et al. Cause of death and factors associated with early in-hospital mortality after hip fracture[J]. Bone Joint J, 2015,97B(2):246-251.
[10]	Thaler HW, Gosch M, Kammerlander C . Orthogeriatrics: hip fracture and its implications[J]. Wien Med Wochenschr, 2013,163(19/20):433-434. doi: 10.1007/s10354-013-0229-x
[11]	Pedersen SJ, Borgbjerg FM, Schousboe B , et al. A comprehensive hip fracture program reduces complication rates and mortality[J]. J Am Geriatr Soc, 2008,56(10):1831-1838. doi: 10.1111/jgs.2008.56.issue-10
[12]	Evaniew N, Bhandari M . Cochrane in CORR^®: intramedullary nails for extracapsular hip fractures in adults (review)[J]. Clin Orthop Relat Res, 2015,473(3):767-774. doi: 10.1007/s11999-014-4123-7
[13]	Shin YS, Chae JE, Kang TW , et al. Prospective randomized study comparing two cephalomedullary nails for elderly intertrochanteric fractures: Zimmer Natural nail versus proximal femoral femoral nail antirotation Ⅱ[J]. Injury, 2017,48(7):1550-1557. doi: 10.1016/j.injury.2017.04.011
[14]	刘中邸, 徐海林, 陈建海 , 等. 解剖型股骨近端髓内钉治疗老年转子间骨折的初步疗效[J]. 中华老年骨科与康复电子杂志, 2017,3(5):265-269.
[15]	Parmar DS, Porecha MM, Chudasama S . Long proximal femoral nails versus short proximal femoral nails for the management of proximal femoral fractures: a retrospective study of 124 patients[J]. Eur J Orthop Surg Traumatol, 2011,21(3):159-164. doi: 10.1007/s00590-010-0683-8
[16]	Chang SM, Song DL, Ma Z , et al. Mismatch of the short straight cephalomedullary 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
[17]	戴尅戎, 戴闵, 郭晓山 , 等. 中国骨科大手术静脉血栓栓塞症预防指南[J]. 中华骨科杂志, 2016,36(2):65-71. doi: 10.3760/cma.j.issn.0253-2352.2016.02.001
[18]	García-Fuster MJ, Fabia MJ, Furió E , et al. Should we look for silent pulmonary embolism in patients with deep venous thrombosis[J]. BMC Cardiovasc Disord, 2014,14(1):178. doi: 10.1186/1471-2261-14-178
[19]	Nosher JL, Patel A, Jagpal S , et al. Endovascular treatment of pulmonary embolism: selective review of available techniques[J]. World J Radiol, 2017,9(12):426-437. doi: 10.4329/wjr.v9.i12.426
[20]	Najafzadeh M, Kim SC, Patterson C , et al. Patients’ perception about risks and benefits of venous thromboembolism (VTE) after orthopedic surgery: a qualitative study[J]. BMC Musculoskelet Disord, 2015,16(1):1-8. doi: 10.1186/s12891-015-0454-0
[21]	Hou G, Zhou F, Tian Y , et al. Predicting the need for blood transfusions in elderly patients with pertrochanteric femoral fractures[J]. Injury, 2014,45(12):1932-1937. doi: 10.1016/j.injury.2014.08.033
[22]	张培训, 薛峰, 安帅 , 等. 股骨近端防旋髓内钉和动力髋螺钉治疗股骨转子间骨折的显性和隐性失血量分析[J]. 北京大学学报(医学版), 2012,44(6):891-894.

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Items	PFNA (n=28)	ZNN (n=31)	P
Average age/years	81.9±7.1	79.0±6.7	0.113
Male/female	8/20	11/20	0.570
Right/left	16/12	13/18	0.243
Time from admission to operation/d	4.6±2.1	4.5±2.0	0.770
Classification of fracture, Ⅰ/Ⅱ/Ⅲ	12/15/1	15/15/1	0.913

Items	PFNA (n=28)	ZNN (n=31)	P
Operation time/min	62.7±14.2	73.6±18.3	0.014
Amount of bleeding/mL	56.8±20.6	68.7±31.6	0.089
Fracture healing time/months	4.6±0.8	4.5±0.7	0.545
Postoperative complications, n(%)	1 (3.6)	1 (3.2)	1
TAD /mm	17.7±5.5	16.5±4.7	0.081
Hip Harris score	91.8±3.6	92.2±3.8	0.700