摘要
目的对比分析PFLCP与PFNA治疗老年不稳定型粗隆间骨折术后恢复的不同时期的疗效差别,探讨各自的最优适应证患者。方法本研究回顾2012年1月1日至2016年12月31日采用PFLCP与PFNA治疗的老年不稳定型粗隆间骨折共计214例,PFLCP组104例,PFNA组110例,并对比两组患者术中指标、术后随访情况及Harris评分。结果PFNA组在手术切口长度、手术时间、术中出血量、部分负重活动时间优于PFLCP组,差异有统计学意义(P<0.05);术后Harris评分PFNA组在第4、12、24周优于PFLCP组,差异有统计学意义(P<0.05),但术后48周两组Harris评分,差异无统计学意义(P>0.05),术后远期并发症和骨折愈合,差异无统计学意义(P>0.05)。结论PFNA与PFLCP在治疗老年不稳定型粗隆间骨折均可获得良好疗效,PFNA手术创伤小,术后骨折即刻稳定度高,康复快;但是对于存在股骨髓腔畸形、大粗隆部严重骨折、粗隆部冠状位骨折以及合并股骨外侧壁严重骨折,部分多发骨干骨折,高血管栓塞风险的患者,是否适合使用髓内固定治疗,我们认为仍需总结更多经验改进技术并获取更多数据支持,目前可以采用PFLCP进行治疗。
Objective To compare and analyze differences in the efficacy of PFLCP and PFNA in the treatment of unstable intertrochanteric fractures in different postoperative recovery period in the elderly,and to explore the optimal adaptive patients.Methods This study reviewed 214 cases of unstable intertrochanteric fractures in the elderly treated with PFLCP and PFNA from January 1,2012 to December 31,2016,including 104 patients in the PFLCP group and 110 patients in the PFNA group.The intraoperative index,postoperative follow-up status and Harris score in the two groups were compared.Results The length of operative incision,operation time,intraoperative blood loss and partial weight-bearing activity in PFNA group were better than those in PFLCP group(P<0.05).The postoperative Harris score in the PFNA group was superior to the PFLCP group at 4,12,and 24 weeks(P<0.05),but there was no difference in Harris score between the two groups at 48 weeks(P>0.05).There were no differences in long-term complications and fracture healing(P>0.05).Conclusion PFNA and PFLCP can achieve good effects in the treatment of unstable intertrochanteric fractures in the elderly.PFNA surgery has advantages of less trauma,immediately high stability of postoperative fractures,and quick recovery.However,for patients with intramedullary canal malformation,severe trochanteric fractures,coronal trochanteric fractures and severe lateral femoral fractures,partial multiple bone fractures,and high risk of vascular embolization,whether they are suitable for intramedullary fixation or not,we believe that it’s needed to summarize more experiences in improvement of techniques and acquire more data to support,and PFLCP can currently be used for treatment.
作者
杨林
杨浩
谭科
王志晖
Yang Lin;Yang Hao;Tan Ke(Department of Orthopedic.Medical Department,Sichuan Academy of Medical Sciences·Sichuan Provincial People's Hospital(East Hospital),Chengdu,Sichuan 610101,China)
出处
《四川医学》
CAS
2019年第12期1227-1231,共5页
Sichuan Medical Journal
关键词
老年
不稳定型粗隆间骨折
股骨近端抗旋髓内钉
股骨近端锁定钢板
HARRIS评分
elderly
unstable intertrochanteric fracture
proximal femoral anti-rotating intramedullary nail
proximal femoral locking plate
Harris score
