中国修复重建外科杂志

中国修复重建外科杂志

股骨近端防旋髓内钉与锁定加压钢板治疗老年脑梗死偏瘫侧股骨转子间骨折的疗效比较

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目的 比较股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)与股骨近端锁定加压钢板(proximal femoral locking compression plate,PFLCP)治疗老年脑梗死偏瘫侧股骨转子间骨折的临床疗效。 方法 对 2013 年 10 月—2017 年 1 月收治并符合选择标准的 67 例老年脑梗死偏瘫侧股骨转子间骨折患者临床资料进行回顾性分析,其中 32 例采用 PFNA 内固定(PFNA 组),35 例采用 PFLCP 内固定(PFLCP 组)。两组患者性别、年龄、损伤侧别、骨折改良 Evans 分型、术前合并内科疾病以及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、术中出血量、术后卧床时间、围术期并发症发生率、骨折愈合时间,以及术后 6 个月及 1 年髋关节 Harris 评分。 结果 两组患者均获随访,随访时间 12~24 个月,平均 14 个月。与 PFLCP 组相比,PFNA 组手术时间短、术中出血少、术后卧床时间短,比较差异均有统计学意义(P<0.05)。X 线片复查示,两组骨折均愈合;PFNA 组骨折愈合时间较 PFLCP 组缩短,但差异无统计学意义(t=0.743,P=0.460)。住院期间,PFNA 组 3 例发生肺部感染、2 例下肢深静脉血栓形成、1 例泌尿系感染,围术期并发症发生率为 18.8%(6/32);PFLCP 组 4 例发生肺部感染、6 例下肢深静脉血栓形成、1 例再次脑梗死、1 例应激性溃疡,围术期并发症发生率为 34.3%(12/35);两组围术期并发症发生率比较,差异无统计学意义(χ2=2.053,P=0.152)。术后 6 个月,PFNA 组 Harris 评分总分以及各单项评分均高于 PFLCP 组(P<0.05)。术后 1 年,PFNA 组 Harris 评分总分及疼痛评分、生活能力评分、行走能力评分与 PFLCP 组相比,差异无统计学意义(P>0.05);但关节畸形及活动度评分明显优于 PFLCP 组(t=4.112,P=0.000)。 结论 与 PFLCP 相比,采用 PFNA 治疗老年脑梗死偏瘫侧股骨转子间骨折具有手术时间短、术中出血少、术后卧床时间短,术后早期髋关节功能恢复更好的优势。

Objective To investigate the difference in the effectiveness between proximal femoral nail anti-rotation (PFNA) and proximal femoral locking compression plate (PFLCP) for intertrochanteric fracture in elderly patients combined with hemiplegia due to cerebral infarction. Methods The clinical data of 67 cases of intertrochanteric femoral fractures combined with hemiplegia due to cerebral infarction between October 2013 and January 2017 were retrospectively analyzed. Among them, 32 cases were treated with PFNA internal fixation (PFNA group), and 35 cases were treated with PFLCP internal fixation (PFLCP group). There was no significant difference in gender, age, injury side, modified Evans classification of fracture, preoperative medical disease, and the time from injury to operation between 2 groups (P>0.05). The operation time, intraoperative blood loss, postoperative bed time, incidence of perioperative complications, time of fracture healing, and hip Harris score at 6 months and 1 year after operation were recorded and compared. Results Both groups were followed up 12-24 months with an average of 14 months. Compared with the PFLCP group, the PFNA group had shorter operation time, less intraoperative blood loss, and shorter bed time, and the differences were significant (P<0.05). X-ray films showed that the fractures healed in both groups. The fracture healing time of the PFNA group was shorter than that of the PFLCP group, but the difference was not significant (t=0.743, P=0.460). During hospitalization, there were 3 cases of pulmonary infection, 2 cases of deep venous thrombosis of lower limbs, and 1 case of urinary tract infection in the PFNA group; and the incidence of perioperative complications was 18.8% (6/32). There were 4 cases of pulmonary infection, 6 cases of deep venous thrombosis of lower limbs, 1 case of recurrent cerebral infarction, and 1 case of stress ulcer in the PFLCP group; and the incidence of perioperative complications was 34.3% (12/35). There was no significant difference in the incidence of perioperative complications between 2 groups (χ2=2.053, P=0.152). At 6 months after operation, the total score and individual scores in the PFNA group were higher than those in the PFLCP group (P<0.05). At 1 year after operation, there was no significant difference in the Harris total score and pain score, life ability score, and walking ability score between the PFNA group and the PFLCP group (P>0.05); However, the joint deformity and activity scores of the PFNA group were significantly better than those of the PFLCP group (t=4.112, P=0.000). Conclusion For intertrochanteric fractures in elderly patients with cerebral infarction hemiplegia, the PFNA has shorter operative time, less intraoperative blood loss, shorter bed time after operation, and better short-term hip function when compared with the PFLCP.

关键词: 股骨转子间骨折; 脑梗死; 偏瘫; 股骨近端防旋髓内钉; 股骨近端锁定加压钢板; 老年患者

Key words: Intertrochanteric fracture; cerebral infarction; hemiplegia; proximal femoral nail anti-rotation; proximal femoral locking compression plate; elderly patients

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