股骨近端锁定接骨板与股骨近端髓内钉治疗老年偏瘫患者股骨转子间骨折疗效对比研究

摘要

目的:探讨老年偏瘫患者股骨转子间骨折, 分别采用股骨近端锁定接骨板与股骨近端髓内针 (PFNA-Ⅱa) 固定方式的优缺点.方法:回顾性分析75例, 因各类心脑血管事件导致偏瘫, 下肢肌肉萎缩, 肌力失衡, 步态失稳;再次意外跌倒发生股骨转子间骨折的患者.分别采用股骨近端外侧锁定接骨板治疗 (股骨近端锁定接骨板组, A组) 和股骨近端髓内固定治疗 (PFNA-Ⅱa组, B组), 对比两种内固定方式对临床疗效影响.结果:Harris评分优良率A组80％, B组86.4％, 两组比较差异无统计学意义 (P>0.05) .A组, 5例发生股骨颈偏转, 股骨颈螺钉松动, 最长延期愈合约18个月, 其中1例发生接骨板断裂, 骨不愈合, 实施二次手术更换外侧接骨板, 并植入人工骨, 二次手术后6个月经X线确认完全骨愈合.B组, 3例发生股骨颈偏转, 但无内固定物松动, 最长延期愈合6个月.结论:老年偏瘫患者股骨转子间骨折, 由于其下肢运动力量和运动轨迹的变化. (1) 以股骨近端外侧锁定接骨板为代表的侧钢板类内固定不能有效提高股骨距的支撑和稳定作用, 增加了手术失败的风险. (2) 以股骨近端髓内钉PFNA-Ⅱa为代表的髓内固定方式较好提高股骨距的支撑和稳定, 更好的保护了股骨外侧皮质, 减小应力遮挡.基于目前对股骨转子间骨折内固定方式选择的一定的共识基础上, 结合本研究对特殊患者术后疗效的分析, 髓内固定方式具有较强的适应证.%Objective:To explore the advantages and disadvantages of locking proximal femoral plate and intramedullary nail fixation in elderly hemiplegic patients with intertrochanteric fracture.Methods:75 cases of hemiplegia, muscle atrophy of lower extremity, imbalance of muscle strength and instability of gait due to all kinds of cardiovascular and cerebrovascular events were retrospectively analyzed, and another accidental fall occurred in patients with intertrochanteric fracture of femur.Proximal locking plate of femur and proximal femoral intramedullary fixation were used respectively.Results:In the proximal femoral lateral plate fixation group, 5 cases suffered from femoral neck deflection, femoral neck screw loosening, and the longest delayed healing contract for 18 months.Among them, 1 case suffered from fracture of the plate, bone nonunion, and secondary operation was performed to replace the lateral plate.The artificial bone was implanted, and 6 months after the second operation, the complete bone union was confirmed by X-ray.PFNA-Ⅱagroup had 3 case of femoral neck deflection, but no internal fixation loosened, and the longest delayed healing was 6 months.Conclusion:In elderly hemiplegic patients with intertrochanteric fracture, the changes of movement force and track of lower extremity. (1) Lateral plate fixation represented by proximal locking plate of femur can not effectively improve the support and stability of femoral distance and increase the risk of failure. (2) The method of intramedullary fixation represented by proximal femoral nail (PFNA-Ⅱa) improved the support and stability of the femoral distance and protected the lateral femoral cortex.Based on the current consensus on the choice of internal fixation for intertrochanteric fracture, combined with the analysis of the effect of this study, the method of intramedullary fixation has strong adaptability.