摘要
目的探讨股骨近端可膨胀髓内钉(expandable proximal femoral nail,EPFN)治疗高龄患者骨质疏松性股骨转子间骨折的临床疗效。方法选取2015年1月至2016年12月我科收治的高龄骨质疏松性转子间骨折患者49例,随机分别采用EPFN和InterTAN进行固定。EPFN组23例,其中男7例,女16例;年龄68~89岁,平均(75.2±6.1)岁;AO/OTA分型31-A2型16例,31-A3型7例。InterTAN组26例,其中男10例,女16例;年龄70~87岁,平均(73.2±2.6)岁;AO/OTA分型31-A2型17例,31-A3型9例。术后对两组手术时间、术中透视时间、术中出血量、手术切口长度、术后负重时间、骨折愈合时间、术后并发症发生率及Harris髋关节功能评分进行评估和比较。结果两组患者均获得24~48周的随访,平均(36.0±6.7)周。EPFN组术后出现褥疮1例,肺部感染1例,InterTAN组术后出现尿路感染1例,对侧股骨颈骨折1例,两组术后并发症发生率比较,差异无统计学意义(P>0.05);EPFN组手术时间、术中透视时间、术中出血量和手术切口长度明显比InterTAN组缩短或减少(P<0.05);两组患者术后负重时间、骨折愈合时间和Harris髋关节功能评分比较,差异无统计学意义(P>0.05)。结论EPFN和InterTAN治疗高龄骨质疏松性股骨转子间骨折均具有创伤小、固定牢靠、可早期活动、并发症少等优点,但EPFN操作简单且在缩短手术时间、减少术中出血量等方面优于InterTAN,更适合身体耐受性差的高龄患者。
Objective To explore the clinical efficacy of expandable proximal femoral nail(EPFN)in the treatment of osteoporotic intertrochanteric fractures in elderly patients.Methods 49 elderly patients with osteoporotic intertrochanteric fractures admitted to our department from January 2015 to December 2016 were selected and randomly fixed with EPFN and InterTAN respectively.There were 23 patients in the EPFN treatment group,including 7 males and 16 females with an average age of(75.2±6.1)years(range:68~89).There were 16 cases of AO/OTA 31-A2 type and 7 cases of 31-A3 type.The InterTAN treatment group had 26 patients,including 10 males and 16 females with an average(73.2±2.6)years old(range:70~87).The operation time,intraoperative fluoroscopy time,intraoperative blood loss,surgical incision length,postoperative weight bearing time,fracture healing time,postoperative complication rate and Harris hip function score were evaluated and compared.Results Patients in both groups were followed up for 24 to 48 weeks,with an average of(36.0±6.7)weeks.There was 1 case of bedsores in the EPFN group,1 case of pulmonary infection,1 case of urinary tract infection after operation in the InterTAN group,1 case of contralateral femoral neck fracture.There was no significant difference in the postoperative complications between the two groups(P>0.05).The operation time,intraoperative fluoroscopy time,intraoperative blood loss,and surgical incision length in the EPFN group were significantly shorter or less than those in the InterTAN group(P<0.05).There was no significant differences of postoperative weight bearing time,fracture healing time and Harris hip function scores between the two groups(P>0.05).Conclusion EPFN and InterTAN for the treatment of elderly osteoporotic intertrochanteric fractures have the advantages of less trauma,firm fixation,early mobility,and fewer complications.However,EPFN is simple to operate and is superior in terms of shortening operation time and reducing intraoperative blood loss.InterTAN is more suitable for elderly patients with poor physical tolerance.
作者
高嘉锴
王陶然
牛志霞
郝赋
王典宝
毕龙
Gao Jiakai;Wang Taoran;Niu Zhixia(Department of Oorthopaedics,Xijing Hospital,Air Force Military Medical University,Xi`an 710032,China)
出处
《实用骨科杂志》
2021年第2期103-107,共5页
Journal of Practical Orthopaedics
关键词
高龄
转子间骨折
可膨胀髓内钉
内固定
senior
intertrochanteric fracture of femur
expandable proximal femoral nail
internal fixation
