【摘要】 [目的]探讨股骨近端外侧壁对股骨近端抗旋转髓内钉(PFNA)内固定手术疗效的影响。[方法] 2016年1月～2018年6月在本院行PFNA手术治疗的股骨粗隆间骨折患者124例,按照术前影像显示外侧壁是否完整,86例列入完整组、38例列入破损组。比较两组围手术期、随访与影像资料。[结果]两组患者手术均顺利完成,无重要血管、神经损伤。完整组在手术时间、术中出血量、术中透视次数、术后引流量方面均优于破裂组,但差异无统计学意义(P>0.05)。随访12个月以上。完整组开始下地行走时间、完全负重活动时间均显著早于破损组(P<0.05)。末次随访时,完整组髋关节伸屈ROM和Harris评分均显著优于破损组(P<0.05)。影像方面,术前两组患者Singh指数的差异无统计学意义(P>0.05)。完整组术后皮质对位差值显著小于破损组(P<0.05),术后两组TAD值的差异无统计学意义(P>0.05)。末次随访时完整组内固定物失败比率显著小于破损组(P<0.05),完整组末次随访时颈干角显著大于破损组(P<0.05)。[结论]股骨近端外侧壁的完整性显著影响PFNA内固定的稳定性。更多还原

【Abstract】 [Objective] To investigate the effect of integrity of proximal lateral femoral wall on the clinical outcomes of proximal femoral nail anti-rotation(PFNA) for intertrochanteric fractures.[Methods] From January 2016 to June 2018, a total of124 patients underwent internal fixation with PFNA for intertrochanteric fractures in our hospital.Based on whether or not the integrity of the lateral wall remained on preoperative images, 86 patients fell into the intact group and 38 patients were in the broken group.The perioperative, follow-up and radiographic data were compared between the two groups.[Results] All patients in both groups had operation performed successfully without iatrogenic injuries to the important blood vessel and nerve.The intact group proved superior to the broken group in operation time, intraoperative blood loss, intraoperative fluoroscopic frequency and postoperative drainage, but without statistically significant differences between them(P>0.05).The follow-up period lasted for more than 12 months.The patients in the intact group returned to ambulation and full-weight bearing activity significantly earlier than those in the broken group(P<0.05).At the latest follow-up, the intact group proved significantly superior to the broken group regarding to ROM and Harris score(P<0.05).With respect to radiographic assessment, the intact group was significantly superior to the broken group in quality of fracture reduction, ratio of fixation failure and femoral neck-shaft angle at the latest follow-up(P<0.05), although no statistical differences were found between them in preoperative Singh index, and tipapex distance(TAD) of the nail after operation(P>0.05).[Conclusion] The integrity of the proximal lateral femoral wall does impact stability of PFNA for femoral intertrochanteric fractures.更多还原