1 衡水市第四人民医院骨科，河北 衡水 053000
目的：分析空心钉辅助股骨近端防旋髓内钉(proximal femoral nail antirotation，PFNA)治疗近股骨颈基底粗隆间骨折的效果。方法：选取220例近股骨颈基底粗隆间骨折患者作为研究对象，将其随机分为研究组和对照组，每组110例。对照组采用PFNA内固定术进行治疗，研究组采用PFNA联合空心钉内固定进行治疗。对两组患者手术时间、术中出血量、切口长度、术后卧床时间、完全负重时间、骨折愈合时间及术后12个月时的Barthel评分、Harris评分、Harris评分优良率进行对比，对两组患者发生下肢深静脉血栓、髋关节内翻、内固定断裂等术后并发症情况进行随访和对比。结果：2组患者的手术时间、术中出血量、切口长度等手术指标的差异均无统计学意义(均P>0.05)。研究组的术后卧床时间、完全负重时间、骨折愈合时间均短于对照组，差异均有统计学意义(均P<0.05)，在术后12个月时，研究组的Barthel评分和Harris评分均高于对照组，差异均有统计意义(均P<0.05)。研究组的Harris评分等级分布优于对照组，Harris评分优良率高于对照组，差异均有统计学意义(均P<0.05)。研究组的术后并发症总发生率低于对照组，差异有统计学意义(P<0.05)。结论：相对于单独应用PFNA内固定方案，在近股骨颈基底粗隆间骨折手术治疗中采用PFNA联合空心钉内固定方案，能够提高治疗效果、促进髋关节功能恢复、减少术后并发症，且不会显著增加手术创伤，有利于达到术后快速外科康复。
Clinical study on cannulated screw assisting PFNA in the treatment of proximal femoral neck basal intertrochanteric fracture
CorrespondingAuthor: WANG Yanbin
This work was supported by Hengshui Science and Technology Project, China (2017014013C-36).
Objective: To analyze the effects of cannulated screw assisting proximal femoral nail antirotation (PFNA) on the treatment of proximal femoral neck basal intertrochanteric fracture. Methods: A total of 220 cases of patients with proximal femoral neck basal intertrochanteric fracture were selected and randomly divided into a study group and a control group, and 110 cases were included into each group. The patients in the control group were treated with PFNA for internal fixation, and the patients in the study group were treated with PFNA combined with cannulated screw for internal fixation. The operation time, intraoperative blood loss, incision length, postoperative bed rest time, full weight-bearing time, fracture healing time and Barthel score, Harris score as well as the excellent and good rate of Harris score at 12 months after the operation between the 2 groups were observed and compared. The postoperative complications such as deep vein thrombosis of lower extremities, coxa vara, and internal fixation fracture between the patients in the two groups were followed up and compared. Results: There was no significant difference in operation time, intraoperative blood loss or incision length between the 2 groups (P>0.05). The postoperative bed rest time, the full weight-bearing time and the fracture healing time in the study group were shorter than those in the control group, and the differences were statistically significant (P<0.05). At 12 months after the operation, Barthel score and Harris score of the patients in the study group were higher than those in the control group, and the differences were statistically significant (P<0.05). The grade distribution of the Harris score in the study group was better than that in the control group, and the excellent and good rate of Harris score was higher than that in the control group, as well as the differences were statistically significant (P<0.05). The total incidence of postoperative complications in the study group was lower than that in the control group, and the difference was statistically significant (P<0.05). Conclusion: Compared with the application of PFNA alone, the application of PFNA combined with cannulated screw for internal fixation in the surgical treatment of proximal femoral neck basal intertrochanteric fracture can improve the treatment effects, promote the recovery of hip joint functions, reduce postoperative complications, and will not significantly increase the surgical traumas, which is conducive to achieve rapid postoperative recovery.
proximal femoral nail antirotation; cannulated screw; proximal femoral neck base; intertrochanteric fracture; therapeutic evaluation