PFNA与InterTan钉治疗老年股骨转子间不稳定性骨折临床疗效的比较:一项前瞻性研究

目的 比较防旋转股骨近端髓内钉（PFNA）与InterTan钉治疗老年股骨转子间不稳定性骨折的临床疗效。方法 采用前瞻性研究方法，纳入102例老年（≥65岁）股骨转子间不稳定骨折（A2.2、A2.3、A3型）患者，按手术方式分为PFNA组[n=48，平均年龄（75.6±6.7）岁]和InterTan组 [n=54，平均年龄（75.3±6.6）岁]。后期随访中，门诊复查时记录Harris髋关节评分，通过电话、查访户籍获知患者死亡与否。结果 两组间基线数据差异无统计学意义，具有可比性。InterTan组手术时间、术中透视次数和术中失血量高于PFNA组（P<0.05），两组住院时间和术后尖顶距差异无统计学意义（P>0.05）。PFNA组有4例患者发生螺钉切出。两组共有3例患者院内死亡（2.9%）。后期随访中，两组骨折愈合时间、Harris髋关节评分差异无统计学意义（P>0.05）。PFNA组和InterTan组中位生存时间分别为33.9和27.4个月，组间差异无统计学意义（P>0.05）。结论 PFNA和InterTan钉治疗老年股骨转子间不稳定性骨折预后相当，PFNA在手术时间、术中透视次数、术中失血量上有一定优势，但有螺钉切出风险。
Objective To compare the clinical efficacy of proximal femoral nail antirotation (PFNA) and InterTan nail in the treatment of unstable femoral intertrochanteric fractures in elderly patients. Methods Totally 102 elderly patients (≥65 years old) with A2.2, A2.3 and A3 type unstable femoral intertrochanteric fractures were enrolled in this prospective study. The patients were divided into PFNA group (n=48, with a mean age of [75.6±6.7] years) and InterTan group (n=54, with a mean age of [75.3±6.6] years) according to the surgical method. During follow-up, the Harris hip score was recorded at the last outpatient review, and the survival information of patients was obtained by telephone interview and census register database. Results There was no significant difference in baseline characteristics of patients between the two groups. The operation time, intraoperative fluoroscopy time and bleeding volume of patients in the InterTan group were significantly higher than those in the PFNA group (P<0.05). There was no significant difference in hospital stays or postoperative spikes between the two groups (P>0.05). Screw cut-out occurred in 4 patients in the PFNA group, and the hospital death occurred in 3 (2.9%) patients in the two groups. There was no significant difference in the healing time and Harris hip score between the two groups during follow-up (P>0.05). The median survival time of patients in the PFNA group and the InterTan group was 33.9 and 27.4 months, respectively, with no significant difference between the two groups (P>0.05). Conclusion PFNA and InterTan nail have similar therapeutic effect on elderly patients with unstable femoral intertrochanteric fractures. PFNA is better in improving operation time, intraoperative fluoroscopy time and intraoperative bleeding volume, but has the risk of screw cutting-out