摘要
背景:关于治疗股骨转子间骨折的内固定物的选择一直存有争议。目的:比较经皮解剖锁定接骨板(anatomical locking plate,ALP)与股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)治疗股骨转子间骨折的疗效。方法方法:本研究采用前瞻随机对照的研究方法纳入2011年5月至2013年6月手术治疗的113例股骨转子间骨折患者。对其分别进行闭合复位经皮ALP与PFNA内固定。记录手术时间、放射时间、切口长度、术中出血量、隐性失血量、复位质量、住院时间、骨折愈合时间、术后并发症、术后行走能力评分及髋关节Harris评分,并进行统计学处理。结果结果:113例患者中58例接受PFNA治疗(PFNA组),55例行ALP治疗(ALP组)。在一年的随访中被评估,两组间基线数据具有可比性。ALP组平均手术时间、手术切口长度均显著长于PFNA组[(71.13±7.56)min vs(59.71±9.63)min,P<0.001;(5.18±1.06)cm vs(3.10±0.48)cm,P<0.001]。PFNA组术后隐性失血量明显多于ALP组[(611.36±81.41)ml vs(439.82±65.98)ml,P<0.001)。但两组间平均放射时间、术中出血量、复位质量、平均住院时间、平均骨折愈合时间、术后并发症、术后行走能力评分及术后1年时髋关节Harris评分均无显著的统计学差异(P>0.05)。结论:PFNA和ALP均是治疗老年不稳定性股骨转子间骨折的有效方法,前者手术时间更短,而后者失血量较少。
Background：The choice of optimal internal fixation devices for intertrochanteric femur fractures is still in dispute. Objective：To compare clinical effectiveness of percutaneous anatomical locking plate （ALP） versus proximal femoral nail antirotation （PFNA） in the treatment of intertrochanteric fractures in elderly patients. Methods：A prospective randomized control study was carried out from May 2011 to June 2013 in 113 elderly patients with intertrochanteric fractures who underwent minimally invasive surgery using the ALP or PFNA. Evaluation variables, includ-ing duration from injury to operation, operation time, radiation time, incision length, intraoperative blood loss and hidden blood loss, reduction quality, hospital stay, fracture healing time, postoperative complications, and postoperative walking ability score, Harris hip score, were used to compare the benefits of these two implants. Results：Among 113 subjects, 55 received ALP and 58 received PFNA. The baseline characteristics of the two groups were comparable. The average operation time and surgical incision in the ALP group were significantly longer than those in the PFNA group （[71.13 ± 7.56] min vs [59.71 ± 9.63] min, [5.18 ± 1.06] cm vs [3.10 ± 0.48] cm, P〈0.001）. Postoperative hidden blood loss in the PFNA group was significantly more than that in the ALP group （[611.36±81.41] ml vs [439.82±65.98] ml, P〈0.001）. But there were no significant differences in terms of radiation time, intraoperative blood loss, quality of reduc-tion, hospital stay, fracture healing time, incidence of postoperative complications, postoperative walking ability or Harris hip score between the two groups （P〉0.05）. Conclusions：Overall, the ALP and PFNA appear to have similar clinical effects in treating intertrochanteric fractures in el-derly patients, although the PFNA provides shorter operation time and there is less blood loss during ALP.
出处
《中国骨与关节外科》
2015年第2期151-156,共6页
Chinese Journal of Bone and Joint Surgery
关键词
髋骨折
骨折固定术
内
骨质疏松
骨板
骨钉
老年人
Hip fractures
Fracture fixation,internal
Osteoporois
Bone plates
Bone nails
Old
