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北京大学学报（医学版） ›› 2019, Vol. 51 ›› Issue (2): 283-287. doi: 10.19723/j.issn.1671-167X.2019.02.016

• 论著 • 上一篇    下一篇

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

陈健1,左才红1,张财义1,杨明2,张培训2,∆()   

  1. 1. 宣城市人民医院骨科,安徽宣城 242000
    2. 北京大学人民医院创伤骨科, 北京 100044
  • 收稿日期:2018-04-20 出版日期:2019-04-18 发布日期:2019-04-26
  • 通讯作者: 张培训 E-mail:zhangpeixun@bjmu.edu.cn

Comparison of the effects of two cephalomedullary nails (zimmer natural nail and proximal femoral nail antirotation) in treatment of elderly intertrochan teric fractures

Jian CHEN1,Cai-hong ZUO1,Cai-yi ZHANG1,Ming YANG2,Pei-xun ZHANG2,∆()   

  1. 1. Department of Orthopaedics, People’s Hospital of Xuancheng City, Xuancheng 242000, Anhui, China;
    2. Department of Traumatology and Orthopaedics, Peking University People’s Hospital, Beijing 100044, China;
  • Received:2018-04-20 Online:2019-04-18 Published:2019-04-26
  • Contact: Pei-xun ZHANG E-mail:zhangpeixun@bjmu.edu.cn

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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

表1

两组患者的临床资料"

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

表2

外科手术治疗结果"

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

图1

病例1,女性,77 岁,左股骨转子间骨折(Evans-Jensen分型 Ⅲ 型),行PFNA内固定术"

图2

病例2,女性,87 岁,左股骨转子间骨折(Evans-Jensen分型ⅠB 型),行ZNN内固定术"

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