摘要
目的 :分析比较PFNA与Inter TAN在老年不稳定型股骨粗隆间骨折的临床疗效及相关并发症。方法:2012年4月至2014年2月采用PFNA和Inter TAN治疗老年不稳定型股骨粗隆间骨折113例,其中PFNA组64例,男25例,女39例,年龄66~85岁,平均(73.3±6.5)岁。Inter TAN组49例,男20例,女29例,年龄65~85岁,平均(74.2±5.4)岁;按股骨粗隆间骨折AO分型,PFNA组(A2型48例,A3型16例);Inter TAN组(A2型37例,A3型12例);受伤至手术时间为3~8 d,平均(4.7±1.2)d。比较患者术中出血量、手术时间、透视时间、股骨外侧壁骨折、骨折愈合时间、股骨干骨折、股骨头螺钉切出、股骨头坏死、股骨颈短缩及末次随访髋关节功能Harris评分。结果:PFNA组58例、InterTAN组44例患者获得随访,时间14~18个月,平均(16.3±1.2)个月;随访期间,患者伤口愈合良好;PFNA组术中出血量、手术时间及术中透视时间明显少于Inter TAN组(P<0.05);在股骨干骨折、头钉切出、股骨颈短缩发生率方面,InterTAN较PFNA更有优势(P<0.05)。末次随访PFNA组Harris髋关节功能评分为90.7±5.1,Inter TAN组为90.4±3.9,,两组差异无统计学意义(P>0.05)。结论:Inter TAN具有较强的抗旋作用,更适合患者早期负重,降低髋关节内翻、头钉切出及股骨颈短缩等并发症发生率;但对于身体耐受能力差、骨质疏松的患者,PFNA更适宜。由于随访时间不长,其远期疗效尚需进一步观察研究。
Objective：To compare the clinical effects of PFNA and Inter TAN for the treatment of unstable intertrochanteric fractures in the elderly patients. Methods：From April 2012 to February 2014,113 elderly patients with unstable intertrochanteric fractures were treated by PFNA or Inter TAN. There were 64 cases in PFNA group,including 25 males and 39 females with an average age of（73.3±6.5） years old（ranged,66 to 85）;while 49 cases in Inter TAN group,including 20 males and 29 females with an average age of（74.2±5.4） years old（ranged,65 to 85）. According to the AO classification,there were 48 cases of type A2,16 cases of type A3 in PFNA group and 37 cases of type A2,12 cases with type A3 in Inter TAN group. The time interval from injury ranged from 3 to 8 days with an average of 4.7±1.2. The blood loss,operation time,fluoroscopy time,lateral cortex fractures of the proximal femur,healing time of fracture,femoral shaft fractures,femoral head screw cut out,necrosis of the femoral head,femoral neck shortening and Harris score of patients at the last follow up were compared between the two groups. Results：Fifty eight patients in PFNA and 44 patients in Inter TAN were followed up for 14 to 18 months with an average of 16.3±1.2. Wound healing was satisfying during the follow up. Significant differences were observed between the two groups regarding the blood loss,operation time,fluoroscopy time. The complication rate of femoral shaft fractures,femoral head screw cut-out and femoral neck shortening in Inter TAN group was less than that in PFNA group,showing significant difference between the two groups（P〉0.05）. At the latest follow up,the average Harris scores were 90.7±5.1 in PFNA group and 90.4±3.9 in Inter TAN group,there was no significant difference between the two groups（P〉0.05）. Conclusion：Inter TAN with stronger anti rotation function is more suitable for patients with early weight bearing and it reduces the incidence rates of hip varus,femoral head screw cut out and femoral nec
作者
张军
曹烈虎
陈晓
苏佳灿
ZHANG Jun CA O Lie-hu CHEN Xiao and SU Jia-can.(Department of Orthopaedics ,Changhai Hospital of Second Military Medical University, Shanghai 200433, Chin)
出处
《中国骨伤》
CAS
2017年第7期597-601,共5页
China Journal of Orthopaedics and Traumatology
关键词
股骨骨折
骨折固定术
内
病例对照研究
Femoral fractures
Fracture fixation
internal
Case control studies
