Feasibility of proximal femoral nail antirotation with small incision in treatment of intertrochanteric fracture in the elderly patients

doi:10.3969/j.issn.2095-4344.2015.09.016

Abstract

Abstract:

BACKGROUND: Internal fixations have achieved good outcomes in treatment of intertrochanteric fracture among the elderly. The commonly used internal fixation methods include extramedullary fixation (dynamic screws) and intramedullary fixation (proximal femoral nail). Although dynamic screws have been widely applied due to low cost and easy operations, the failure rate of internal fixation is relatively high. Intramedullary fixation can make up for the shortcomings of extramedullary fixation.
OBJECTIVE: To evaluate the feasibility of proximal femoral nail antirotation with small incision in treatment of intertrochanteric fracture in the elder patients, and to compare with dynamic screws.
METHODS: From August 2012 to June 2013, 40 elderly patients with unstable intertrochanteric fractures were included in this study and were randomly divided into two groups: experimental group and control group. Patients in the experimental group were given proximal femoral nail antirotation with small incision, while patients in the control group were treated with dynamic screws internal fixation. Postoperative index and Harris score of hip functions in the two groups were compared.
RESULTS AND CONCLUSION: There was no differences in the Harris score of hip functions between the two groups (P > 0.05), while the experimental group showed shorter operation time and hospital stay, less blood loss and complications then the control group (P < 0.05). Compared with dynamic screws internal fixation, proximal
femoral nail antirotation therapy with small incision shows good repairing effects, with fewer complications, small trauma and high healing rate, it is suitable for the treatment of intertrochanteric fractures among the elderly patients.

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: Femur, Fractures, Bone, Internal Fixators

CLC Number:

R318

Shi Shao-hua, Lv Shu-jun. Feasibility of proximal femoral nail antirotation with small incision in treatment of intertrochanteric fracture in the elderly patients [J]. Chinese Journal of Tissue Engineering Research, 2015, 19(9): 1405-1409.

Figures/Tables 2

2.2 基线资料比较两组患者基线资料比较差异无显著性意义(P > 0.05)，具有可比性，见表1。 2.3 两组患者的髋关节功能Harris评分比较观察组与对照组患者的髋关节功能Harris评分差异无显著性意义，见表2。对两组患者不同AO分型的髋关节功能Harris评分对比分析发现，治疗后老年患者的髋关节功能均得到了明显改善，见表3，4。 2.4 两组患者的手术相关指标比较两组相比，观察组患者的手术时间和住院时间均较对照组患者短，观察组患者的出血量较对照组少，同时观察组患者的并发症发生率也较对照组少，见表5。 2.5 典型病例防旋股骨近端髓内钉组典型病例：女性，67岁，不慎从床上摔下，感左髋部疼痛，功能障碍1 d入院。入院查体：左侧转子区压痛，局部轻度肿胀、瘀斑，外旋畸形明显，约90°，有轴向叩击痛，左下肢不能活动，测量见患肢较对侧短缩约2.5 cm。患者停经近20年，有高血压病史20余年。于入院后4 d行左转子间骨折闭合复位防旋股骨近端髓内钉内固定。术后切口一期愈合，2周拆线，住院期间无压疮、下肢深静脉血栓形成及其他骨科并发症发生。鼓励患者于术后第1天，即开始进行患侧股四头肌收缩运动, 术后第5天扶拐下地不负重活动，术后6周时部分负重活动，患者于术后3个半月复查左髋关节X射线片时，弃拐行走左髋部也无疼痛，示骨折已经愈合，见图2。动力髋螺钉组典型病例：男性，70岁，骑自行车时摔伤，右髋部剧烈疼痛进入本院骨科，查体：右侧转子区压痛，外旋畸形明显，右下肢不能活动，测量见患肢短缩约1.5 cm。患者有高血压病史，无其他内科合并疾病。入院后给予患肢皮牵引，消肿、止疼对症等治疗，完善术前检查，无明显手术禁忌。行右转子间骨折切开复位内固定。术后切口一期愈合，2周拆线。术后第5天可以借助外力下床不负重活动，术后5周时能下床部分负重活动，患者于术后3个月复查右髋关节X射线片时，局部无压痛及轴向叩击痛，弃拐行走右髋部也无疼痛，示骨折已经愈合，见图3。 2.6 不良事件对比两组术后常见并发症发现，髋内翻内固定松动、感染、压疮等并发症在老年股骨转子间骨折术后比较常见，对照组并发症的发生率高于观察组，差异有显著性意义(P < 0.05)，见表6。"

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