[1]王喆,李盛龙,汤欣,等.InterTAN与 PFNA-II髓内固定系统在老年髋部骨折中的临床疗效分析[J].中华老年骨科与康复电子杂志,2017,(04):216-222.[doi:10.3877/cma.j.issn.2096-0263.2017.04.005]
　Wang Zhe,Li Shenglong,Tang Xin,et al.InterTAN versus PFNA- II intramedullary nailing in the treatment of geriatric femoral intertrochanteric fractures[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(04):216-222.[doi:10.3877/cma.j.issn.2096-0263.2017.04.005]
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InterTAN与 PFNA-II髓内固定系统在老年髋部骨折中的临床疗效分析()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2017年04期
页码:
216-222
栏目:
髋部骨折
出版日期:
2017-07-15

文章信息/Info

Title:
InterTAN versus PFNA- II intramedullary nailing in the treatment of geriatric femoral intertrochanteric fractures
作者:
王喆 1; 李盛龙 2; 汤欣 3; 李骁腾 3; 王秀会 4; 郭胜洋 3; 陈韬 3; 黄辽江 3; 张德强 3
200032 上海，复旦大学附属中山医院骨科 1；110042 沈阳，中国医科大学肿瘤医院 辽宁省肿瘤医院骨与软组织外科 2；116011 大连医科大学附属第一医院创伤骨科 3；201318 上海市浦东新区周浦医院骨科 4
Author(s):
Wang Zhe1;  Li Shenglong2;  Tang Xin3;  Li Xiaoteng3;  Wang Xiuhui4;  Guo Shengyang3;  Chen Tao3;  Huang Liaojiang3;  Zhang Deqiang3
1Department of Orthopedics, ZhongShan Hospital Affiliated to Fudan University, Shanghai 200032, China; 2Department of Bone and Soft Tissue Tumor Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang 110042, China; 3Department of Orthopedic Trauma, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China; 4Department of Orthopedics, Pudong New District Zhoupu Hospital, Shanghai 201318, China
关键词:
髋骨折;  骨折固定术; 髓内;  Inter TAN;  PFNA-II
Keywords:
Hip fractures;  Fracture fixation;  intramedullary;  InterTAN;  PFNA-II
DOI:
10.3877/cma.j.issn.2096-0263.2017.04.005
文献标志码:
A
摘要:
目的 比较联合加压交锁髓内钉系统（InterTAN）及股骨近端抗旋髓内钉（PFNA-Ⅱ）在老年转子间骨折的临床疗效及预后评价。方法 回顾性分析 3个中心（大连医科大学附属第一医院创伤骨科，中国医科大学附属肿瘤医院骨与软组织外科以及上海市健康医学院附属周浦医院骨科）2008年 12月至 2015年 1月收治的符合纳入排除标准的股骨转子间骨折患者资料 363例，按照内固定材料不同分为 InterTAN组（IT组，n=188）以及 PFNA-Ⅱ组（PA组，n=175）。采用独立功能评分（FIM）系统、坐位起立-行走时间（TUG）评分系统以及 Harris评分系统进行功能评价以及疗效评定，随访并比较两组患者在术后出院时、出院 6 w、3个月、6个月、12个月及 24个月各指标的变化。结果 236例患者获得完整随访，随访率为 65%，随访时间为 24～74个月，平均（36±18）个月。IT组患者 2年死亡率[35.1%（66/188）]与 PA组[34.8%（61/175）]相比，差异无统计学意义。IT组患者手术时间及术中累计透视时间（[ 63±31）min、（5.8±1.8）s]均高于 PA 组患者（[ 42±28）min、（3.1±1.2）s]，差异具有统计学意义（t=0.844，t=2.995； P＜0.05）。42例患者接受“二次手术”治疗（IT组 23例，PA组 19例）（12.23% vs 10.85%），但组间差异无统计学意义。两组患者“在二次手术”的方式比较，差异具有统计学意义（t=0.851，P＜0.05）。两组下肢短缩＞2 cm、内固定周围骨折、同侧股骨远端骨折、同侧股骨头骨折比较，差异具有统计学意义（c2=2.041，c2=1.682，c2=4.063，c2=-5.948，P＜0.05）。两组患者在术后 24个月的随访中 FIM评分、TUG 评分以及 Harris髋关节评分比较差异无统计学意义。结论 两种髓内固定系统在两年随访中临床疗效以及预后评价基本一致，而 InterTAN治疗活动能力较强且不稳定型转子间骨折的老年患者较 PFNA能够更有效的降低术后并发症，提高临床治疗效果。
Abstract:
Objective To compare the clinical efficacy and prognosis between two types of intramedullary nailings (InterTAN vs PFNA-Ⅱ) in the treatment of geriatric femoral intertrochanteric fractures. Methods A retrospective analysis was conducted including 500 cases selected from 3 medical centers (The First Affiliated Hospital of Dalian Medical University, Department of Bone and Soft Tissue Tumor Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Department of Orthopedics, Shanghai Zhoupu Hospital affiliated to Shanghai University of Medicine & Health Science) diagnosed as intertrochanteric fractures from Dec. 2008 to Jan. 2015, 363 cases were followed up completely for 2 years and were divided into IT group (188 cases) and PA group (175 cases) according to different treatments. Pre- operative, hospital- stay and post- operative surgery-related indexes, Functional Independence Measure (FIM), Time UP and Go test (TUG) and Harris scoring system for hip function were applied for on clinical evaluation and functional recovery at discharge, 6 weeks, 3 months, 6 months, 1 year and 2 years postoperatively. Results 236 cases were completely followed up for 24 to 74 month (35.52±17.88 monthes), the rate of complete follow-up was 65%. 2-year mortality in IT group (66/188) were no significantly different from that in PA group [35.1%(66/188) vs 34.8%(61/175)]. Operative time [(63±31) vs (42±28) mins] and intra-operative fluoroscopic time [(5.8±1.8) vs (3.1±1.2) secs] were found significantly difference in 2 groups (t=- 0.844, t=2.995; P<0.05). Forty- two cases had underwent“re- operation”for implant-related revisions and fracture fixation, but there was no significant difference between IT group (23 cases, 12.23%) and PA group (19 cases, 10.85%). However, type of re-operation were found significantly different (t=0.851, P<0.05) between 2 groups. As for post- operative complication, shortening greater than 2cm, perio- prothestic fractures, ipslateral distal femoral fractures and femoral head fractures were significantly difference (c2=2.041, 2c =1.682, c2=4.063, c2=- 5.948, P<0.05). There was no significant difference over time in follow- up of 2 yearswiththe evaluation ofFIM system,TUG system andHarris scoring system.Conclusion It can be expected that most patients with intertrochanteric hip fractures can be treated either InterTAN or PFNA-II regarding to similar long-term clinical outcomes and functional recoveries. However, High-activity patients with unstable types of intertrochanteric fractures were expected better clinical efficacy using InterTAN than PFNA- II, which may lower the incidence of post-operative complications and improve clinical outcomes.

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更新日期/Last Update: 2017-07-14