骨质疏松股骨转子间骨折老年患者应用骨水泥增强型PFNA的疗效观察

郭岳; 闫军; 哈承志; 杨鸿鹏

doi:10.16766/j.cnki.issn.1674-4152.003374

骨质疏松股骨转子间骨折老年患者应用骨水泥增强型PFNA的疗效观察

doi: 10.16766/j.cnki.issn.1674-4152.003374

聊城市人民医院骨科，山东聊城 252000

基金项目:

山东省自然科学基金项目 ZR2021MH248

详细信息

通讯作者:
杨鸿鹏，E-mail：qwee20230220@163.com

中图分类号: R683.42 R687.33
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出版历程
- 收稿日期: 2023-05-22
- 网络出版日期: 2024-03-27

Curative effect of cement-enhanced PFNA on the elderly with osteoporotic intertrochanteric fracture

Orthopedics Department, Liaocheng People's Hospital, Liaocheng, Shandong 252000, China

摘要

摘要: 目的观察应用骨水泥增强型股骨近端防旋髓内钉(PFNA)治疗老年骨质疏松性股骨转子间骨折的疗效和术后恢复情况，评价PFNA的应用效果。方法选取2020年1月—2022年1月聊城市人民医院收治的80例老年骨质疏松性股骨转子间骨折的患者，采用随机数字表法分为2组，PFNA组(40例)接受传统PFNA术，骨水泥增强组(40例)接受骨水泥增强型PFNA治疗，收集患者临床资料。术后12个月测量Harris评分，记录并发症发生情况。结果 2组患者术中相关指标比较差异均无统计学意义(P>0.05)。骨水泥增强组患者下床时间[(5.08±0.96)d]、负重时间[(3.14±0.38)周]和骨折愈合时间[(12.33±1.29)周]均明显少于PFNA组[(7.37±1.01)d、(4.92±0.56)周、(17.64±1.75)周, P < 0.05]。术后12个月，PFNA组和骨水泥增强组患者疼痛、功能和肢体畸形髋关节Harris评分差异均无统计学意义(P>0.05)，骨水泥增强组活动范围髋关节Harris评分明显高于PFNA组[(4.93±0.58)分vs. (4.61±0.52)分，P < 0.05]。骨水泥增强组患者并发症发生率明显低于PFNA组(P < 0.05)。结论骨水泥增强型PFNA术是治疗老年骨质疏松性股骨转子间骨折的理想术式，其安全性高，稳定性高，能够实现早期负重康复训练，有助于恢复关节功能。
- 骨水泥增强型股骨近端防旋髓内钉 /
- 骨质疏松 /
- 老年 /
- 股骨转子间骨折 /
- Harris评分 /
- 并发症
Abstract: Objective To observe the effect and postoperative recovery of cement-enhanced proximal femoral nail anti-rotation (PFNA) in the treatment of the elderly with osteoporotic intertrochanteric fractures, and to evaluate the application effect of PFNA. Methods A total of 80 elderly patients with osteoporotic intertrochanteric fractures admitted to Liaocheng People's Hospital were enrolled from January 2020 to January 2022. According to the random grouping method, they were divided into the PFNA group (traditional PFNA, n=40) and the cement-enhanced group (cement-enhanced PFNA, n=40). The clinical data of patients were collected. Twelve months after surgery, the Harris score was measured, and the occurrence of complications was recorded. Results There was no significant difference in intraoperative relevant indexes between the two groups (P>0.05). The leaving bedtime, weight-bearing time, and fracture healing time in the cement-enhanced group were (5.08±0.96) d, (3.14±0.38) weeks and (12.33±1.29) weeks, which were significantly shorter than those in PFNA group [(7.37±1.01) d, (4.92±0.56) weeks, (17.64±1.75) weeks, P < 0.05]. Twelve months after surgery, there was no significant difference in hip Harris scores (pain, function, limb deformity) between the two groups (P>0.05), but the hip Harris score (range of motion) in the cement-enhanced group was significantly higher than that in the PFNA group [(4.93±0.58) points vs. (4.61±0.52) points, P < 0.05]. The incidence of complications in the cement-enhanced group was significantly lower than that in the PFNA group (P < 0.05). Conclusion Cement-enhanced PFNA is an ideal operation in the treatment of the elderly with osteoporotic intertrochanteric fracture, with high safety and stability. It can realize early weight-bearing rehabilitation training and is beneficial to recover joint function.
- Cement-enhanced proximal femoral nail anti-rotation /
- Osteoporosis /
- Old age /
- Intertrochanteric fracture /
- Harris score /
- Complication

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表 1 PFNA组和骨水泥增强组老年骨质疏松性股骨转子间骨折患者一般资料比较

Table 1. Comparison of general data in elderly patients with osteoporotic intertrochanteric fracture between PFNA group and cement-enhanced group

项目	PFNA组 (n=40)	骨水泥增强组 (n=40)	统计量	P值
性别[例(%)]			1.867^a	0.172
女性	29(72.50)	34(85.00)
男性	11(27.50)	6(15.00)
年龄(x±s, 岁)	71.73±8.59	72.36±8.68	0.326^b	0.745
骨密度T值(x±s)	-2.94±0.25	-2.88±0.31	0.953^b	0.344
骨折部位[例(%)]			0.450^a	0.502
左侧	22(55.00)	19(47.50)
右侧	18(45.00)	21(52.50)
AO分型[例(%)]			0.312^a	0.576
A2	31(77.50)	33(82.50)
A3	9(22.50)	7(17.50)
骨折原因[例(%)]			0.957^a	0.620
摔伤	32(80.00)	30(75.00)
交通伤	5(12.50)	8(20.00)
其他	3(7.50)	2(5.00)
Evans分型[例(%)]			0.341^c	0.557
Ⅰ	6(15.00)	9(22.50)
Ⅱ	8(20.00)	6(15.00)
Ⅲ	14(35.00)	15(37.50)
Ⅳ	7(17.50)	6(15.00)
Ⅴ	5(12.50)	4(10.00)
合并症[例(%)]
糖尿病	6(15.00)	4(10.00)	0.457^a	0.499
高血压	11(27.50)	12(30.00)	0.061^a	0.805
心功能不全	3(7.50)	5(12.50)	0.556^a	0.456
注：^a为χ²值，^b为t值，^c为Z值。

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表 2 PFNA组和骨水泥增强组老年骨质疏松性股骨转子间骨折患者手术情况比较(x±s)

Table 2. Comparison of surgical situations in elderly patients with osteoporotic intertrochanteric fracture between PFNA group and cement-enhanced group (x±s)

组别	例数	术中出血量 (mL)	总输血量 (mL)	手术用时 (min)
PFNA组	40	161.47±21.31	206.58±57.05	53.48±7.90
骨水泥增强组	40	160.85±21.46	185.23±51.28	55.76±8.25
t值		0.130	1.760	1.262
P值		0.897	0.082	0.211

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表 3 PFNA组和骨水泥增强组老年骨质疏松性股骨转子间骨折的患者术后恢复情况比较(x±s)

Table 3. Comparison of postoperative recovery in elderly patients with osteoporotic intertrochanteric fracture between PFNA group and cement-enhanced group (x±s)

组别	例数	下床时间 (d)	负重时间 (周)	骨折愈合时间 (周)
PFNA组	40	7.37±1.01	4.92±0.56	17.64±1.75
骨水泥增强组	40	5.08±0.96	3.14±0.38	12.33±1.29
t值		10.394	16.635	15.447
P值		< 0.001	< 0.001	< 0.001
注：骨折愈合时间定义为影像学显示有明显骨小梁穿过骨折线。

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表 4 PFNA组和骨水泥增强组老年骨质疏松性股骨转子间骨折的患者髋关节Harris评分比较(x±s, 分)

Table 4. Comparison of hip Harris scores in elderly patients with osteoporotic intertrochanteric fracture between PFNA group and cement-enhanced group (x±s, points)

组别	例数	疼痛	功能	活动范围	肢体畸形
PFNA组	40	39.76±3.25	40.47±4.31	4.61±0.52	3.85±0.23
骨水泥增强组	40	40.48±2.91	41.88±4.46	4.93±0.58	3.94±0.19
t值		1.044	1.438	2.598	1.908
P值		0.300	0.154	0.011	0.060

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表 5 PFNA组和骨水泥增强组老年骨质疏松性股骨转子间骨折的患者并发症发生情况比较

Table 5. Comparison of complications in elderly patients with osteoporotic intertrochanteric fracture between PFNA group and cement-enhanced group

组别	例数	髋内翻(例)	再骨折(例)	螺旋刀片切出(例)	感染(例)	合计[例(%)]
PFNA组	40	1	2	5	3	11(27.50)
骨水泥增强组	40	0	1	0	2	3(7.50)
注：2组并发症发生率比较，χ²=5.541，P=0.019。

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