不同的手术方法治疗老年股骨粗隆间骨折的疗效及生物力学研究
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贵州省黔西南州人民医院

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Study of the effect and biomechanics of different surgical methods in the treatment of intertrochanteric fracture of femur in the elderly
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贵州省黔西南州人民医院

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    摘要:

    摘要:目的:分析股骨近端锁定钢板(LPFP)和股骨近端抗旋髓内钉(PFNA)内固定术治疗老年股骨粗隆间骨折的疗效及生物力学性能。方法:将我院收治的106例老年股骨粗隆间骨折患者随机分为LPFP治疗组53例和PFNA治疗组53例,于治疗干预后分别统计2组患者的手术时间、术中出血量、负重时间、骨折愈合时间及术后9个月Harris髋关节功能评分,统计2组患者术后并发症的发生率;同时,取新鲜老年股骨标本10具制备老年股骨粗隆间骨折模型,并将其随机分为PFNA组和LPFP组各5具,于治疗干预后采用力学试验机进行轴向压缩实验、破坏载荷实验和扭转刚度实验,记录生物力学性能指标。结果:在平均手术时间、负重时间及骨折愈合时间上,PFNA组均短于LPFP组(P<0.05);且PFNA组平均术中出血量少于LPFP组(P<0.05),平均Harris评分高于LPFP组(P<0.05)。在术后并发症总发生率上,PFNA组、LPFP组依次为7.56%、18.87%,2组比较,差异具有统计学意义(P<0.05)。骨折模型治疗干预后,在平均轴向压缩、破坏载荷指标值上,PFNA组均高于LPFP组(P<0.05);在平均扭转刚度指标值上,PFNA组低于LPFP组(P<0.05)。结论:相较于LPFP,在老年股骨粗隆间骨折的治疗中PFNA创伤小,且凭借其良好的生物力学性能可有效促进骨折愈合和髋关节功能的恢复,且能够显著减少髋内翻和螺钉松动与切割并发症的发生率。

    Abstract:

    Abstract:Objective: To analyze the efficacy and biomechanical properties of proximal femoral locking plate (LPFP) and proximal femoral anti-rotating intramedullary nail (PFNA) in the treatment of intertrochanteric fracture in elderly patients.Methods: 106 elderly patients with intertrochanteric fracture of femur in our hospital were randomly divided into LPFP group (53 cases) and PFNA group (53 cases). After treatment intervention, the operation time, intraoperative bleeding volume, weight-bearing time, fracture healing time and Harris hip function score of 9 months after operation in the two groups were counted. The complications after operation in the two groups were analyzed. At the same time, 10 fresh old femoral specimens were selected to prepare the model of intertrochanteric fracture of femur in the elderly. They were randomly divided into PFNA group and LPFP group with 5 in each group. After treatment and intervention, axial compression test, destructive load test and torsional stiffness test were carried out by mechanical testing machine, and biomechanical properties were recorded.Results: The average operation time, weight-bearing time and fracture healing time in PFNA group were shorter than those in LPFP group (P < 0.05), and the average intraoperative bleeding volume in PFNA group was less than that in LPFP group (P < 0.05), and the average Harris score was higher than that in LPFP group (P < 0.05). The total incidence of postoperative complications in PFNA group and LPFP group was 7.56% and 18.87% respectively. There was a significant difference between the two groups (P < 0.05). After intervention of fracture model treatment, the average values of axial compression and damage load in PFNA group were higher than those in LPFP group (P < 0.05), and the average values of torsional stiffness in PFNA group were lower than those in LPFP group (P < 0.05). Conclusion:Compared with LPFP, PFNA has less trauma in the treatment of intertrochanteric femoral fractures in the elderly. With its good biomechanical properties, PFNA can effectively promote fracture healing and hip function recovery, and significantly reduce the incidence of hip varus, screw loosening and cutting complications.

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  • 收稿日期:2019-08-07
  • 最后修改日期:2019-10-23
  • 录用日期:2019-11-12
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