| PFNA与InterTAN髓内钉治疗不稳定股骨粗隆间骨折疗效的比较 |
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投稿时间：2017-02-20
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| 作者 | Author | 单位 | Address | E-Mail |
| 张军 |
ZHANG Jun |
第二军医大学附属长海医院创伤骨科, 上海 200433 |
Department of Orthopaedics, Changhai Hospital of Second Military Medical University, Shanghai 200433, China |
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| 曹烈虎 |
CAO Lie-hu |
第二军医大学附属长海医院创伤骨科, 上海 200433 |
Department of Orthopaedics, Changhai Hospital of Second Military Medical University, Shanghai 200433, China |
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| 陈晓 |
CHEN Xiao |
第二军医大学附属长海医院创伤骨科, 上海 200433 |
Department of Orthopaedics, Changhai Hospital of Second Military Medical University, Shanghai 200433, China |
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| 苏佳灿 |
SU Jia-can |
第二军医大学附属长海医院创伤骨科, 上海 200433 |
Department of Orthopaedics, Changhai Hospital of Second Military Medical University, Shanghai 200433, China |
drsujiacan@163.com |
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| 期刊信息：《中国骨伤》2017年，第30卷，第7期，第597-601页 |
| DOI：10.3969/j.issn.1003-0034.2017.07.003 |
| 基金项目: |
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中文摘要:
目的：分析比较PFNA与InterTAN在老年不稳定型股骨粗隆间骨折的临床疗效及相关并发症。
方法：2012年4月至2014年2月采用PFNA和InterTAN治疗老年不稳定型股骨粗隆间骨折113例，其中PFNA组64例，男25例，女39例，年龄66~85岁，平均（73.3±6.5）岁。InterTAN组49例，男20例，女29例，年龄65~85岁，平均（74.2±5.4）岁；按股骨粗隆间骨折AO分型，PFNA组（A2型48例，A3型16例）；InterTAN组（A2型37例，A3型12例）；受伤至手术时间为3~8 d，平均（4.7±1.2） d。比较患者术中出血量、手术时间、透视时间、股骨外侧壁骨折、骨折愈合时间、股骨干骨折、股骨头螺钉切出、股骨头坏死、股骨颈短缩及末次随访髋关节功能Harris评分。
结果：PFNA组58例、InterTAN组44例患者获得随访，时间14~18个月，平均（16.3±1.2）个月；随访期间，患者伤口愈合良好；PFNA组术中出血量、手术时间及术中透视时间明显少于InterTAN组（P<0.05）；在股骨干骨折、头钉切出、股骨颈短缩发生率方面，InterTAN较PFNA更有优势（P<0.05）。末次随访PFNA组Harris髋关节功能评分为90.7±5.1，InterTAN组为90.4±3.9，，两组差异无统计学意义（P>0.05）。
结论：InterTAN具有较强的抗旋作用，更适合患者早期负重，降低髋关节内翻、头钉切出及股骨颈短缩等并发症发生率；但对于身体耐受能力差、骨质疏松的患者，PFNA更适宜。由于随访时间不长，其远期疗效尚需进一步观察研究。 |
| 【关键词】股骨骨折 骨折固定术,内 病例对照研究 |
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| Comparison of PFNA and InterTAN intramedullary nail in treating unstable femoral intertrochanteric fractures |
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ABSTRACT
Objective: To compare the clinical effects of PFNA and InterTAN for the treatment of unstable intertrochanteric fractures in the elderly patients.
Methods: From April 2012 to February 2014,113 elderly patients with unstable intertrochanteric fractures were treated by PFNA or InterTAN. There were 64 cases in PFNA group,including 25 males and 39 females with an average age of (73.3±6.5) years old (ranged,66 to 85);while 49 cases in InterTAN group,including 20 males and 29 females with an average age of (74.2±5.4) years old (ranged,65 to 85). According to the AO classification,there were 48 cases of type A2,16 cases of type A3 in PFNA group and 37 cases of type A2,12 cases with type A3 in InterTAN group. The time interval from injury ranged from 3 to 8 days with an average of 4.7±1.2. The blood loss,operation time,fluoroscopy time,lateral cortex fractures of the proximal femur,healing time of fracture,femoral shaft fractures,femoral head screw cut-out,necrosis of the femoral head,femoral neck shortening and Harris score of patients at the last follow-up were compared between the two groups.
Results: Fifty-eight patients in PFNA and 44 patients in InterTAN were followed up for 14 to 18 months with an average of 16.3±1.2. Wound healing was satisfying during the follow-up. Significant differences were observed between the two groups regarding the blood loss,operation time,fluoroscopy time. The complication rate of femoral shaft fractures,femoral head screw cut-out and femoral neck shortening in InterTAN group was less than that in PFNA group,showing significant difference between the two groups (P<0.05). At the latest follow-up,the average Harris scores were 90.7±5.1 in PFNA group and 90.4±3.9 in InterTAN group,there was no significant difference between the two groups(P>0.05).
Conclusion: InterTAN with stronger anti-rotation function is more suitable for patients with early weight-bearing and it reduces the incidence rates of hip varus,femoral head screw cut-out and femoral neck shortening. However,for those patients with osteoporosis or unfit for surgery,PFNA is a good option. As the limited follow-up duration,long-term effects of the two surgical methods needs to be further observed and studied. |
| KEY WORDS Femoral fractures Fracture fixation,internal Case-control studies |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 张军,曹烈虎,陈晓,苏佳灿.PFNA与InterTAN髓内钉治疗不稳定股骨粗隆间骨折疗效的比较[J].中国骨伤,2017,30(7):597~601 |
| 英文格式: | ZHANG Jun,CAO Lie-hu,CHEN Xiao,SU Jia-can.Comparison of PFNA and InterTAN intramedullary nail in treating unstable femoral intertrochanteric fractures[J].zhongguo gu shang / China J Orthop Trauma ,2017,30(7):597~601 |
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