股骨近端防旋髓内钉联合空心拉力螺钉治疗涉及外侧壁破裂的股骨转子间骨折

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摘要目的探讨股骨近端防旋髓内钉(proximal femoral nail antirotation，PFNA)联合空心拉力螺钉治疗涉及外侧壁破裂的股骨转子间骨折临床疗效。方法回顾分析2017年9月至2019年9月收治的涉及外侧壁破裂的60例老年股骨转子间骨折患者临床资料，根据是否重建外侧壁分为A组(PFNA组，30例)和B组(PFNA+空心拉力螺钉重建外侧壁组，30例)。A组男13例，女17例；年龄65～90岁，平均(76.0±2.5)岁；左侧12例，右侧18例。B组男16例，女14例；年龄65～90岁，平均(75.0±2.5)岁；左侧17例，右侧13例。两组患者性别、年龄、侧别、致伤原因、受伤至手术时间等一般资料比较差异均无统计学意义(P＞0.05)。记录并比较两组患者手术时间、术中失血量、骨折愈合时间、术后并发症、术后2个月尖顶距(tip apex distance，TAD)值；术后12个月采用Harris髋关节评分进行功能评价。结果两组患者均获随访，随访时间9～16个月，平均12个月。两组术中出血量及术后2个月TAD比较差异无统计学意义(P＞0.05)。但B组手术时间明显长于A组(t＝1.48，P＝0.045)；A组术后有5例发生并发症(16.6%)，包括主钉断裂1例，髋內翻、骨不连2例(再次手术行人工髋关节置换术)；退钉2例(于术后1年取出螺旋刀片)。B组有3例发生并发症(10%)，包括髓内钉远端再折1例(更换全长髓内钉)，退钉1例(术后1年取出螺旋刀片)，股骨头缺血坏死1例(已行人工关节翻修术)；两组并发症发生率比较差异无统计学意义(P＞0.05)。A组骨折愈合时间(10.4±1.5)周，明显长于B组(6.7±2.1)周，差异有统计学意义(t＝2.064，P＝0.023)。术后12个月进行Harris髋关节评分，B组(87.7±3.7)分，明显优于A组(84.6±2.9)分(t＝2.98，P＝0.01)。结论针对外侧壁破裂股骨转子间骨折治疗，同单纯PFNA治疗相比，联合空心拉力螺钉重建外侧壁后可显著缩短骨折愈合时间，降低内植物失效风险，快速恢复患者日常生活能力。

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	郭大春
	郑章
	黄斌鑫 *
	徐爱飞

关键词 ：股骨转子间骨折, 股骨近端防旋髓内钉, 外侧壁, 空心拉力螺钉

Abstract：Objective To review the results of proximal femoral nail antirotation (PFNA) combined with cannulate screw for reconstruction of lateral femoral wall in the treatment of intertrochanteric fracture.Methods The clinical data of 60 elderly patients with intertrochanteric fractures involved in lateral wall rupture from September 2017 to September 2019 were retrospectively analyzed.They were divided into group A (PFNA alone，30 cases) and group B (PFNA combined with cannulate screw reconstruction of lateral femoral wall，30 cases).There was no significant difference in general information such as gender，age，side，cause of injury，and time from injury to operation between the two groups (P＞0.05).The operation time，intraoperative blood loss，fracture healing time，postoperative complications，and tip apex distance (TAD) were compared between the two groups.The Harris hip score was used to evaluate the function 12 months after operation.Results The two groups were followed up for 9 to 16 months，with an average of 12 months.There was no significant difference in intraoperative blood loss and TAD at 2 months after operation in the two groups (P＞0.05).The operation time in group B was significantly longer than that in group A (t＝1.48，P＝0.045)；there were 5 complications (16.6%) occurred in group A after operation，including 1 case of main nail fracture，2 cases of displacement and nonunion (reoperation was performed again by artificial hip replacement)；2 patients with screw pull-out.There were 3 complications (10%)occurred in group B，including one case with fracture again in the intramedullary nail distal (reoperation was performed again by the full-length intramedullary nail).1 case with screw pull-out，and 1 case with ischemic necrosis of the femoral head (reoperation was performed again by artificial hip replacement)；there was no significant difference in the incidence of complications between the two groups (P＞0.05) .But，the fracture healing time in group A was significantly longer than that group B，showing significant difference(t＝2.064，P＝0.023).According to the Harris hip score at 12 months after operation，group B was significantly better than group A (t＝2.98，P＝0.01).Conclusion Compared with PFNA alone，the treatment of intertrochanteric fracture with PFNA combined with cannulate screw reconstruction of lateral femoral wall can significantly reduce postoperative complications，promote fracture healing，and quickly restore the daily life ability of patients.

Key words： intertrochanteric fracture proximal femoral nail antirotation lateral femoral wall cannulated screw

作者简介: 郭大春(1988－ )，男，主治医师，重庆开州光明骨科医院，405400。

引用本文:

郭大春，郑章，黄斌鑫 *，徐爱飞. 股骨近端防旋髓内钉联合空心拉力螺钉治疗涉及外侧壁破裂的股骨转子间骨折[J]. 实用骨科杂志, 2020, 26(7): 583-586.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2020/V26/I7/583

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