股骨近端钉(PFN)与动态髁螺钉(DCS)治疗不稳定转子骨折的比较研究。

IF 1.4 Q3 EMERGENCY MEDICINE International Journal of Burns and Trauma Pub Date : 2022-06-15 eCollection Date: 2022-01-01
Md Faraz Jamil, Julfiqar Mohd, Mazhar Abbas, Yasir Salam Siddiqui, Mohammad Jesan Khan
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引用次数: 0

摘要

股骨粗隆骨折非常常见,其中35-40%的骨折不稳定。转子骨折,尤其是不稳定的转子骨折,具有很高的死亡率和发病率,因此对于外科医生来说,选择合适的植入物来治疗这些骨折仍然是一个巨大的挑战。本研究的目的是比较股骨近端钉与动力髁螺钉在治疗不稳定转子骨折中的作用。我们的研究是一项前瞻性比较研究,纳入26例新生(≤3周龄)不稳定粗隆骨折AO 31A2和AO 31A3患者,年龄≥18岁。DCS组11例,PFN组15例。Harris髋关节评分用于比较功能结果。DCS组患者平均年龄59.82±11.59岁,PFN组患者平均年龄54.2±16.22岁。DCS组AO 31A2型骨折发生率高于AO 31A3型(63.64%),PFN组AO 31A3型骨折发生率高于AO 31A2型(60.00%)。DCS的平均手术时间为96.36±15.51 min, PFN的平均手术时间为79.67±12.02 min, p值为0.003。DCS组2例,PFN组1例无随访。DCS组2例死亡,PFN组1例死亡。DCS组11例患者中有7例(63.64%)得以随访,PFN组15例患者中有13例(86.60%)得以随访。DCS患者2例(28.57%)愈合,PFN固定患者12例(92.31%)愈合,p值为0.007。DCS组平均HHS为62.29±24.26,PFN组平均HHS为86.92±11.65,p值为0.037。DCS组和PFN组合并优、良HHS患者分别为2例(28.57%)和11例(84.62%)。5例(71.43%)DCS固定不愈合,1例(7.69%)PFN固定不愈合。DCS组内固定失败3例(42.86%),其中2例(28.57%)髋臼钢板断裂,1例(14.29%)和1例(7.69%)PFN组内翻塌陷及螺钉完全脱出。DCS组内翻3例(42.86%),PFN组内翻4例(30.76%)。与动态髁螺钉相比,股骨近端钉是更好的植入物,在更短的手术时间、更高的愈合率和更好的功能预后方面具有统计学意义。因此,与DCS相比,PFN是治疗不稳定转子骨折的更好选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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A comparative study of Proximal Femoral Nail (PFN) versus Dynamic Condylar Screw (DCS) in management of unstable trochanteric fractures.

Trochanteric hip fractures have become very common with 35-40% of these fractures being unstable. Trochanteric fractures, especially unstable ones are associated with high rates of mortality and morbidity and thus remain an inordinate challenge for surgeon to treat these fractures with proper choice of implant. Aim of the study was to compare the proximal femoral nail and dynamic condylar screw in the management of unstable trochanteric fractures. Our study was a prospective comparative study which included 26 patients with fresh (≤3 weeks old) unstable trochanteric fractures AO 31A2 and AO 31A3, with age ≥18 years of both sexes. Eleven patients in DCS and fifteen patients in PFN were included. Harris hip score was used to compare functional outcomes. Average age of patients in DCS group was 59.82±11.59 years and PFN was 54.2±16.22 years. AO 31A2 fracture pattern (63.64%) was more common than AO 31A3 in DCS group and AO 31A3 fracture pattern (60.00%) was more common than AO 31A2 in PFN group. Mean operative time for DCS was 96.36±15.51 minutes and for PFN it was 79.67±12.02 minutes with P-value of 0.003. Two patients in DCS group and 1 patient in PFN group were lost to follow up. Two patients in DCS group and 1 patient in PFN group died. Seven out of 11 (63.64%) patients in DCS group and 13 out of 15 (86.60%) patients in PFN group were available for final follow up. Union seen in 2 (28.57%) patients with DCS and 12 (92.31%) patients fixed with PFN with P-value of 0.007. Mean HHS of 62.29±24.26 in DCS and 86.92±11.65 in PFN with P-value of 0.037. Patients with combined excellent and good HHS in DCS group and PFN group were 2 (28.57%) and 11 (84.62%) respectively. Non-union was seen in 5 (71.43%) patients fixed with DCS and 1 (7.69%) patient fixed with PFN. Implant failure was seen in 3 (42.86%) patients in DCS group in which barrel plate was broken in 2 (28.57%) patients and lag screw cut out through femoral head in 1 (14.29%) patient and 1 (7.69%) patient in PFN group due to varus collapse and complete backout of screw. Varus collapse was seen in 3 (42.86%) patients in DCS group and 4 (30.76%) patients in PFN group. Proximal femoral nail is better implant as compared to dynamic condylar screw which was statistically significant in terms of lesser operative time, higher union rate and better functional outcome. So PFN is a better implant choice for unstable trochanteric fractures when compared with DCS.

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