Anatomical dynamic hip lock plate and proximal femoral nail antirotation repair intertrochanteric fracture of femur in the elderly: 16-month follow-up

doi:10.3969/j.issn.2095-4344.2015.04.024

Abstract

Abstract:

BACKGROUND: Active fixation for intertrochanteric fracture of femur in the elderly has been recognized by us, but which fixation mode can be selected remains unclear.

OBJECTIVE: To compare the therapeutic effects of anatomical dynamic hip lock plate and proximal femoral nail antirotation on repair of intertrochanteric fracture, and to explore the significance of fixation choice.

METHODS: A total of 87 patients with elderly osteoporotic intertrochanteric fractures, who were treated in the Department of Orthopedics, Shekou People’s Hospital of Nanshan District of Shenzhen City from August 2009 to April 2014, were enrolled in this study. They received anatomical dynamic hip lock plate (lock plate group) and proximal femoral nail antirotation (nail antirotation group) separately. Ambulation time, load time, healing time, the degree of functional recovery and complications were compared between the two groups.

RESULTS AND CONCLUSION: All patients were followed up for 16 to 24 months, averagely 19 months. The healing time was about 11 weeks in the lock plate and nail antirotation groups. At 2 weeks after repair, no significant difference was detected in Harris hip score (P > 0.05). The ambulation time and load time were shorter in nail antirotation group than in the lock plate group (P < 0.01). Four patients meant to receive proximal femoral nail antirotation, but finally received anatomical dynamic hip lock plate due to intertrochanteric diastema, narrow femoral canal and great curvature of the femur. During follow-up, coxa vara was found in one patient from the lock plate group. Fractures occurred again due to impact injury in one patient of the nail antirotation group. Results indicated that the two fixation methods for treating intertrochanteric fracture obtained good therapeutic effects. Suitable repair mode and implant can be selected according to patient’s conditions.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: Femoral Fractures, Fracture Fixation, Fracture Fixation, Intramedullary, Recovery of Function, Hip Joint

CLC Number:

R318

Shao Yun-feng, Zhang Xiang-sheng. Anatomical dynamic hip lock plate and proximal femoral nail antirotation repair intertrochanteric fracture of femur in the elderly: 16-month follow-up[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(4): 629-633.

Figures/Tables 4

2.1 参与者数量分析所有患者治疗后随访16-24个月，平均19个月，无脱落，按意向性处理分析，87例患者均进入结果分析。分组流程图见图3。 2.2 两组患者基线资料比较由表1可见，锁定钢板组和防旋髓内钉组患者的性别构成、年龄、骨折分型及合并症比较差异无显著性意义(P > 0.05)，有可比性。 2.3 两组患者骨折愈合及髋关节功能恢复情况锁定钢板组和防旋髓内钉组患者骨折愈合时间及术后2 周Harris 髋关节功能评分比较差异无显著性意义(P > 0.05)，但防旋髓内钉组患者下地活动时间及负重时间短于锁定钢板组(P < 0.01)，见表2。 2.4 两组患者手术过程中指标比较锁定钢板组和防旋髓内钉组手术时间、术中出血量、术中X射线暴露次数及术后引流量比较差异无显著性意义(P > 0.05)，见表2。 2.5 不良事件及材料宿主反应住院期间两组患者均无伤口感染及死亡，两组中均未发生下肢深静脉血栓。随访过程中，锁定钢板组1例患者发生髋内翻，防旋髓内钉组1例患者因撞击伤再次发生骨折。手术过程中有4例患者拟行防旋型股骨近端髓内钉内固定，因患者股骨转子纵裂(2例)、股骨髓腔狭小(1例)及股骨弧度较大(1例)而术中更改选择解剖型髋动力锁定钢板。两组中均未发生材料宿主反应。 2.6 典型病例锁定钢板组典型病例：患者女性，74岁，因摔伤致右髋部疼痛伴活动受限2 h入院，查体及X射线片提示右股骨转子间粉碎性骨折，患者既往有糖尿病及高血压病史。行解剖型髋动力锁定钢板内固定修复股骨转子间骨折，见图4。防旋髓内钉组典型病例：患者男性，85岁，因摔伤致右髋部疼痛伴活动受限3 h入院，查体及X射线片提示右股骨转子间粉碎性骨折，患者既往有糖尿病及前列腺手术病史。行防旋型股骨近端髓内钉内固定修复股骨转子间骨折，见图5。"

References

[1] Mereddy P, Kamath S, Ramakrishnan M,et al.The AO/ASIF proximal femoral nail antirotation (PFNA): a new design for the treatment of unstable proximal femoral fractures.Injury. 2009; 40(4):428-432.

[2] Kim SY, Kim YG, Hwang JK.Cementless calcar-replacement hemiarthroplasty compared with intramedullary fixation of unstable intertrochanteric fractures. A prospective, randomized study.J Bone Joint Surg Am. 2005;87(10): 2186-2192.

[3] 赵海生,杨兴,孙俊英.股骨近端髓内钉-螺旋刀片置入治疗股骨转子间骨折32例[J].中国组织工程研究与临床康复,2009,13(35): 6959-6963.

[4] 郑斌,王文晔,谢孝枫,等.防旋股骨近端髓内钉治疗股骨粗隆间骨折98例体会[J].泰山医学院学报,2012,33(7): 518-520.

[5] 林辉,张岩.防旋型股骨近端髓内钉治疗老年性股骨粗隆间骨折[J].中国矫形外科杂志,2012,20(20):1913-1914.

[6] 熊鹰,王大兴,柳百炼,等.解剖型髋动力带锁钢板的研制及临床应用[J].中国矫形外科杂志,2008,16(6):419-422.

[7] 黄异飞,潘静,熊鹰. 解剖型髋动力带锁钢板治疗股骨转子间骨折的疗效评价[J].中华创伤杂志,2009,25(1):61-65.

[8] 曹正品,黄俊涛,苏仕奎,等.髋动力锁定钢板治疗不稳定型股骨转子间骨折[J].临床骨科杂志,2010,13(1):47-48.

[9] Kaplan K, Miyamoto R, Levine BR, et al.Surgical management of hip fractures: an evidence-based review of the literature. II: intertrochanteric fractures.J Am Acad Orthop Surg. 2008;16(11): 665-673.

[10] 黄小英,孔来法.髋动力锁定钢板治疗老年股骨转子间骨折29例[J].浙江创伤外科,2011,19(5): 614-615.

[11] 杨明.髋动力锁定钢板治疗22例股骨转子间骨折体会[J].江西医药,2012,47(10):874-875.

[12] 黄诚,付聪聪,黄相杰.DHS和PFNA治疗老年骨质疏松性转子间骨折的临床疗效对比[J].中国矫形外科杂志,2014, 22(6): 568-570.

[13] 茹江英,丛宇,仓海斌,等.老年股骨粗隆间骨折PFNA内固定术后失效的翻修方法及效果分析[J].中国骨与关节损伤杂志,2014, 29(2): 129-131.

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