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中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2021, Vol. 07 ›› Issue (05) : 277 -283. doi: 10.3877/cma.j.issn.2096-0263.2021.05.005

髋部骨折

PFNA与DHS治疗Seinsheimer V型股骨粗隆下骨折合并肌少症的疗效比较
侯传勇1, 刘新晖1, 殷建1,†()   
  1. 1. 211100　南京，南京医科大学附属江宁医院骨科
  • 收稿日期:2021-01-13 出版日期:2021-10-05
  • 通信作者: 殷建
  • 基金资助:
    江苏省自然科学基金(SBK2019022658); 南京医科大学康达学院科研发展基金(KD2019KYJJZD021); 南京市卫健委科技发展资金(YKK19130)

Comparative study of PFNA and DHS for the treatment of Seinsheimer V-type of femoral subtrochanteric fracture with sarcopenia

Chuanyong Hou1, Xinhui Liu1, Jian Yin1,†()   

  1. 1. Department of Orthopedics, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, China
  • Received:2021-01-13 Published:2021-10-05
  • Corresponding author: Jian Yin
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侯传勇, 刘新晖, 殷建. PFNA与DHS治疗Seinsheimer V型股骨粗隆下骨折合并肌少症的疗效比较[J]. 中华老年骨科与康复电子杂志, 2021, 07(05): 277-283.

Chuanyong Hou, Xinhui Liu, Jian Yin. Comparative study of PFNA and DHS for the treatment of Seinsheimer V-type of femoral subtrochanteric fracture with sarcopenia[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2021, 07(05): 277-283.

目的

比较股骨近端髓内钉（PFNA）与动力髋螺钉（DHS）治疗Seinsheimer V型股骨粗隆下骨折合并肌少症手术的疗效。

方法

回顾性分析2016年1月至2018年12月南京医科大学附属江宁医院骨科收治手术的Seinsheimer V型股骨粗隆下骨折合并肌少症患者52例。根据握力及骨骼肌指数（SMI）诊断肌少症。根据手术方式的不同分为PFNA组（28例）和DHS组（24例）。比较两组患者年龄、性别、受伤至手术时间、SMI值、切口长度、手术时间、术中出血量、透视次数，围手术期输血量、下肢完全负重时间、术后3个月和末次随访时的疼痛视觉模拟评分（VAS）和髋关节Harris功能评分，以及术后并发症情况。

结果

所有患者均获得随访。两组患者年龄、性别、受伤至手术时间和SMI之间差异无统计学意义（t=0.054，P=0.957；χ2=0.018，P=0.894；t=0.044，P=0.965；t=-1.298，P=0.200）。PFNA组手术切口长度、出血量和输血量少于DHS组，术中透视次数多于DHS组，差异具有统计学意义（t=-13.016，P=0.000；t=-5.305，P=0.000；t=-2.505，P=0.016；t=9.293，P=0.000），两组手术时间差异无统计学意义（t=0.432，P=0.668）。PFNA组完全负重时间较早、术后3个月VAS评分较低，而Harris评分较高，差异具有统计学意义（t=-3.874，P=0.000；z=-2.009，P=0.045；t=7.139，P=0.000），但末次随访时两组VAS评分和Harris评分差异无统计学意义（z=-1.166，P=0.243；t=0.733，P=0.468）。PFNA组1例发生内固定松动，并发症的发生率为3.57%，DHS组2例发生伤口感染，5例发生内固定松动，并发症的发生率为29.17%，差异具有统计学意义（χ2=4.686，P=0.030）。

结论

PFNA和DHS均是治疗Seinsheimer V型股骨粗隆下骨折合并肌少症的有效方法，但PFNA手术切口短，出血量少，恢复较快，并发症发生率较低，可优先选择。

关键词: 髋骨折, 肌少症, 髓内钉, 动力髋螺钉
Objective

Comparison of the efficacy of proximal femoral nail antirotation (PFNA) and dynamic hip screw (DHS) in the treatment of seinsheimer v-type of subtrochanteric fracture with sarcopenia.

Methods

From January 2016 to December 2018, 52 patients with seinsheimer V-type subtrochanteric fracture complicated with sarcopenia were retrospectively analyzed. Sarcopenia was diagnosed by grip strength and skeletal muscle index (SMI). They were divided into PFNA group (28 cases) and DHS group (24 cases). The age, gender, injury to operation time, SMI value, incision length, operation time, intraoperative blood loss, fluoroscopy times, perioperative blood transfusion, lower limb full weight-bearing time, visual analogue scale (VAS) and Harris score at 3 months and the last follow-up were compared between the two groups, as well as the complications.

Results

All patients were followed up. There was no significant difference in age, gender, injury to operation time and SMI between the two groups (t=0.054, P=0.957, χ2=0.018, P=0.894, t=0.044, P=0.965, t=-1.298, P=0.200). The incision length, blood loss and blood transfusion in PFNA group were less than those in DHS group, and the number of fluoroscopy in operation was more than that in DHS group (t=-13.016, P=0.000, t=-5.305, P=0.000, t=-2.505, P=0.016, t=9.293, P=0.000). There was no significant difference in operation time between the two groups (t=0.432, P=0.668). In PFNA group, the time of complete weight-bearing was earlier, the VAS score was lower 3 months after operation, but the Harris score was higher, the difference was statistically significant (t=-3.874, P=0.000; z=-2.009, P=0.045; t=7.139, P=0.000), but there was no significant difference in VAS score and Harris score between the two groups at the last follow-up (z=-1.166, P=0.243; t=0.733, P=0.468). In PFNA group, 1 case had internal fixation loosening, and the incidence of complications was 3.57%. In DHS group, 2 cases had wound infection, and 5 cases had internal fixation loosening, and the incidence of complications was 29.17%. The difference was statistically significant (χ2=4.686, P=0.030).

Conclusions

PFNA and DHS are both effective methods in the treatment of seinsheimer V type subtrochanteric fracture with sarcopenia, but PFNA has shorter incision, less blood loss, faster recovery and lower incidence of complications, which can be preferred.

Key words: Hip fractures, Sarcopenia, PFNA, DHS
图4~6 女性，72岁，诊断为股骨粗隆下骨折合并肌少症，行DHS手术。图4　术前X线正位片；图5　术后第二天复查X线正位片；图6　末次随访时复查X线正位片
表1 两组股骨粗隆下骨折患者一般情况比较
组别 例数 年龄（岁，±s） 性别（例，男/女） 受伤至手术时间（d，±s） SMI（cm2/m2，±s）
PFNA组 28 65±8 18/10 3.4±1.6 28±6
DSH组 24 65±10 15/9 3.4±1.3 31±7
统计值   0.054 0.018 0.044 -1.298
P值   0.957 0.894 0.965 0.200
表2 两组股骨粗隆下骨折患者手术相关指标的比较（±s）
组别 切口长度（cm） 出血量（ml） 输血量（ml） 透视次数（次） 手术时间（min）
PFNA组 6.5±0.9 172±118 214±224 19.1±6.5 93±37
DSH组 11.0±1.5 418±200 375±238 6.8±2.4 88±44
统计值 -13.016 -5.305 -2.505 9.293 0.432
P值 <0.01 <0.01 0.016 <0.01 0.668
表3 两组股骨粗隆下骨折患者骨折愈合情况及髋关节功能比较
组别 负重时间（月） 术后3个月VAS（分） 末次随访时VAS（分） 统计值 P值
PFNA组 14.7±2.2 1.00（0.25，3.00） 0.00（0.00，1.00） -4.091 <0.01
DSH组 18.2±3.9 2.00（1.00，4.00） 0.50（0.00，1.00） -4.146 <0.01
统计值 -3.874 -2.009 -1.166    
P值 <0.01 0.045 0.243    
组别 术后3个月Harris（分） 末次随访时Harris（分） 统计值 P值 并发症(例)（%）
PFNA组 79.8±4.4 87.8±3.2 -29.933 <0.01 1(3.57%)
DSH组 72.9±2.5 87.0±4.4 -30.744 <0.01 7（29.17%）
统计值 7.139 0.733     4.686
P值 <0.01 0.468     0.030
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