股骨近端仿生髓内钉固定股骨粗隆间骨折近期结果
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常州市武进中医医院

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国家骨科与运动康复临床医学研究中心创新基金(2021-NCRC-CXJJ-PY-28);常州市青苗人才项目(编号:CZQM2020121)


Short-term outcomes of proximal femoral bionic intramedullary nail in the treatment of femoral intertrochanteric fractures
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Wujin affiliated Hospital of Nanjing University of Chinese Medicine

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    摘要:

    目的 观察股骨近端仿生髓内钉(PFBN)治疗老年股骨粗隆间骨折的近期疗效,并与股骨近端抗旋髓内钉(proximal femoral nail antirotation, PFNA)进行比较。方法 选取2020年10月至2021年8月期间本院收治的40例老年股骨粗隆间骨折患者,随机分为PFBN组和PFNA组,比较两组围手术期、随访与影像资料。结果 两组患者随访时间6-9个月,平均(7.33±1.14)个月,末次随访时无患者死亡,切口均一期愈合,无切口感染、神经血管损伤,骨折不愈合、内固定切出等并发症。两组术中出血量、切口愈合、住院时间无显著差异(p>0.05)。PFBN组手术用时比PFNA更长(p<0.05)。PFBN组患者下地时间和完全负重时间显著早于PFNA组(p<0.05)。PFBN组切口总长度较PFNA组更长(p<0.05)。术中透视PFBN组较PFNA组次数更多(p<0.05)。与术后1月相比,末次随访时两组VAS评分显著降低,Harris评分及髋关节屈伸和内-外旋ROM显著增加(p<0.05)。术后1月时,PFBN组的Harris评分优于PFNA组,差异有统计学意义(p<0.05)。影像方面,两组骨折愈合时间无显著差异(p>0.05),末次随访时,PFBN组颈干角维持要优于PFNA组(p<0.05)。结论 股骨近端仿生髓内钉固定更为稳定,允许患者早期下地行走,有利于骨折愈合,防止髋内翻发生。

    Abstract:

    Objective To observe the short-term outcomes of femoral bionic intramedullary nail (PFBN) in the treatment of elderly femoral intertrochanteric fractures, and to compare it with proximal femoral nail anti-rotation (PFNA). Methods Forty elderly patients with femoral intertrochanteric fractures admitted to our hospital from March 2021 to December 2021 were selected and randomly divided into PFBN group and PFNA group. The perioperative period, follow-up and imaging data were compared between the two groups. Results The follow-up time of the two groups of patients was 6-9 months, with an average of (7.33±1.14) months. No patient died at the final follow-up. There was no significant difference in operation time, intraoperative blood loss, incision healing and hospital stay duration between the two groups (p>0.05). The time to partial and complete weight-bearing in the PFBN group were significantly earlier than those in the PFNA group (p < 0.05). The total length of the incision in the PFBN group was longer than that in the PFNA group (p<0.05). The frequency of intraoperative fluoroscopy in the PFBN group was more than that in the PFNA group (p<0.05). Compared with 1 month after operation, the VAS scores of the two groups at the final follow-up were significantly decreased, and the Harris scores and hip flexion-extension and internal-external rotation ROM were significantly increased (p < 0.05). At 1 month after operation, the Harris score of the PFBN group was better than that of the PFNA group, and the difference was statistically significant (p<0.05). In terms of imaging, there was no significant difference in fracture healing time between the two groups (p>0.05). At the final follow-up, the maintenance of the neck-shaft angle in the PFBN group was better than that in the PFNA group (p<0.05). Conclusion The fixation of the proximal femoral bionic intramedullary nail is more stable, allowing the patient to walk on the ground early, which is conducive to fracture healing and prevents the occurrence of coxa varus.

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  • 收稿日期:2022-01-09
  • 最后修改日期:2022-03-29
  • 录用日期:2022-08-05
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