PFNA-II 主钉长度对A1、2型股骨转子间骨折患者临床疗效及安全性的影响

Effect of main nail length of PFNA-II on clinical efficacy and safety of patients with intertrochanteric fractures of type A1 and A2

摘要:

目的探讨亚洲型股骨近端防旋髓内钉（PFNA-Ⅱ）主钉长度对A1、2 型股骨转子间骨折患者临床效及安全性的影响。方法选取2012 年4 月-2015 年4 月本院收治急A1、2 型股骨转子间骨折患者60 例，以随机数字表法分为A 组和B组各30 例，分别选择240 mm 主钉和170 mm主钉行PFNA-Ⅱ术式治疗；比较两组患者围手术期临床指标水平、股骨前皮质主钉抵触率、随访Harris 髋关节功能评分及术后并发症发生率等。结果A 组患者手术时间为（64.82±11.54）min，显性失血量为（156.34±35.16）ml，隐性失血量为（258.86±51.95）ml，住院时间为（9.76±1.26）d；B 组患者手术时间为（45.31±7.89）min，显性失血量为（94.70±17.33）ml，隐性失血量为（176.25±40.71）ml，住院时间为（9.51±1.20）d，经检验，差异有统计学意义（P <0.05），B 组患者手术时间、显性失血量、隐性失血量及住院时间均优于A 组；A组患者输血率为46.67%（14/30），B 组患者输血率为20.00%（6/30），经χ2 检验，差异有统计学意义（P <0.05），B组患者输血率低于A组；A 组患者股骨前皮质主钉抵触率为53.33%（16/30），B组患者股骨前皮质主钉抵触率为13.33%（4/30）；经χ2 检验，差异有统计学意义（P <0.05），B组患者股骨前皮质主钉抵触率低于A组；A 组患者随访Harris髋关节功能评分为（80.76±4.33）分，B 组患者随访Harris髋关节功能评分为（81.23±4.42）分，经检验，差异无统计学意义（P >0.05）；A 组患者术后并发症发生率为6.67%（2/30），B 组患者术后并发症发生率为3.33%（1/30），经χ2 检验，差异无统计学意义（P >0.05）。结论相较于240 mm 主钉，选择170 mm 主钉行PFNA-Ⅱ术式治疗A1、2 型股骨转子间骨折具 有操作简便、微创及术后恢复时间短等优势，且未影响髋关节功能恢复效果和增加术后并发症发生风险。

Abstract:

Objective To investigate the effect of the main nail length of Proximal Femoral Nail Antirotation for Asian type (PFNA-Ⅱ) on the clinical efficacy and safety of patients with intertrochanteric fracture of type A1 or A2. Methods Sixty patients with intertrochanteric fracture of type A1 or 2 were chosen in the period from April 2012 to April 2015 in our hospital and randomly divided into group A (30 patients) with main nail length of 240 mm and group B (30 patients) with main nail length of 170 mm for PFNA-Ⅱ. The peri-operative indicator values, the rate of nail tip anterior abutment, the Harris function score of hip during follow-up and the incidence of postoperative complications were compared between the two groups. Results The operation time, the dominant blood loss, the hidden blood loss and the hospital staying time were (64.82 ±11.54) min, (156.34 ±35.16) ml, (258.86 ±51.95) ml and (9.76 ±1.26) d respectively in the group A, and were(45.31 ±7.89) min, (94.70 ±17.33) ml, (176.25 ±40.71) ml and (9.51 ±1.20) d respectively in the group B. The operation time and the hospital staying time were significantly shorter, the dominant blood loss and the hidden blood loss were significantly less in the group B compared to the group A (P < 0.05). The blood transfusion rate of the group A and the group B were separately 46.67%(14/30) and 20.00%(6/30). The blood transfusion rate of the group B was significantly lower than that of the group A (x2 = 4.800, P= 0.028). The rate of nail tip anterior abutment of the group A and the group B were separately 53.33%(16/30) and 13.33%(4/30). The rate of nail tip anterior abutment of the group B was significantly lower than that of the group A (x2 =10.800,P = 0.001). The Harris function score of hip during follow-up was (80.76 ±4.33) points in the group A and (81.23 ±4.42) points in the group B, there was no significant difference between the two groups (t =1.075, P= 0.283). The incidence of postoperative complications was 6.67% (2/30) in the group A and 3.33%(1/30) in the group B, there was no significant difference between the two groups (x2 = 0.352, P= 0.554). Conclusions Compared with main nail length of 240 mm, main nail length of 170 mm for PFNA-Ⅱin the treatment of patients with intertrochanteric fracture of type A1 or A2 possesses the advantages including simple operation, minimal invasion and short recovery time without influnece on the hip joint function recovery or increase the risk of postoperative complications.