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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
引用本文:

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/OL]. 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/OL]. 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=9.293P=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。

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.

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
表2 两组股骨粗隆下骨折患者手术相关指标的比较(±s
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
1
Trafton PG. Subtrochanteric-intertrochanteric femoral fractures[J]. Orthop Clin North Am, 1987, 18(1): 59-71.
2
Medda S, Reeves RA, Pilson H, et al. Subtrochanteric femur fractures[J]. Orthop Clin North Am, 2004, 35(4): 473-483.
3
Derogatis MJ, Kanakamedala AC, Egol KA. Management of subtrochanteric femoral fracture nonunions[J]. JBJS Rev, 2020, 8(6): e1900143.
4
Seinsheimer F. Subtrochanteric fractures of the femur[J]. J Bone Joint Surg Br, 1978, 60(3): 300-306.
5
Giannoudis PV. Surgical priorities in damage control in polytrauma[J]. J Bone Joint Surg Br, 2003, 85(4): 478-483.
6
Xie H, Xie L, Wang J, et al. Intramedullary versus extramedullary fixation for the treatment of subtrochanteric fracture: A systematic review and meta-analysis[J]. Int J Surg, 2019, 63: 43-57.
7
Kuzyk PR, Bhandari M, Mckee MD, et al. Intramedullary versus extramedullary fixation for subtrochanteric femur fractures[J]. J Orthop Trauma, 2009, 23(6): 465-470.
8
Saini P, Kumar R, Shekhawat V, et al. Biological fixation of comminuted subtrochanteric fractures with proximal femur locking compression plate[J]. Injury, 2013, 44(2): 226-231.
9
Laubscher C, Burger M, Conradie M, et al. Prevalence of Sarcopenia in Older South African Patients Following Surgery for Fragility Fractures of the Hip[J]. Geriatr Orthop Surg Rehabil, 2020, 11: 2151459320971560.
10
姜珊,康琳,刘晓红. 2019亚洲肌少症诊断及治疗共识解读[J]. 中华老年医学杂志202039(04):373-376.
11
Nemec U, Heidinger B, Sokas C, et al. Diagnosing sarcopenia on thoracic computed tomography: quantitative assessment of skeletal muscle mass in patients undergoing transcatheter aortic valve replacement[J]. Acad Radiol, 2017, 24(9): 1154-1161.
12
Accreditata XP, Cipollaro L, Aicale R, et al. Single- versus double-integrated screws in intramedullary nailing systems for surgical management of extracapsular hip fractures in the elderly: a systematic review[J]. J Biol Regul Homeost Agents, 2019, 33(2 Suppl. 1): 175-182.
13
Prasarn ML, Ahn J, Helfet DL, et al. Bisphosphonate-associated femur fractures have high complication rates with operative fixation[J]. Clin Orthop Relat Res, 2012, 470(8): 2295-2301.
14
De Vries JS, Kloen P, Borens O, et al. Treatment of subtrochanteric nonunions[J]. Injury, 2006, 37(2): 203-211.
15
曲磊,李计东,李博,等. 双反牵引复位结合PFNA治疗股骨粗隆间骨折的初步临床应用[J]. 中华老年骨科与康复电子杂志20206(2):94-98.
16
赵清斌,肖伟,阿布都艾尼·热吾提,等. 空心螺钉捆绑带结合半髋关节置换治疗高龄粗隆间骨折的近期疗效[J]. 中华老年骨科与康复电子杂志2020 (2):88-93.
17
喻鑫罡,郭彦杰,高悠水,等. 多轴锁定钢板倒置与髓内钉治疗老年股骨粗隆下骨折的疗效分析[J]. 中华老年骨科与康复电子杂志20175(3):20-24.
18
Paloma BB, Sagrario MA, José CJA, et al. Peripheral IL-6 Levels but not Sarcopenia Are Predictive of 1-Year Mortality After Hip Fracture in Older Patients[J]. J Gerontol A Biol Sci Med Sci, 2020, 75(10): 130-137.
19
Laubscher CV, Burger MC, Conradie MM, et al. Prevalence of Sarcopenia in Older South African Patients Following Surgery for Fragility Fractures of the Hip[J]. Geriatr Orthop Surg Rehabil, 2020, 26(11): 2151459320971560.
20
侯传勇,刘新晖,张海龙,等. 肌少症对老年患者髋部骨折术后远近期死亡率的影响[J]. 中华老年骨科与康复电子杂志202006(3):136-141.
21
贡歌,万文辉,王斌,等. 肌少症对老年股骨颈骨折患者手术疗效的影响. 中华老年医学杂志201938(2):191-195.
22
Colón C, Molina-Vicenty IL, Frontera-Rodríguez M, et al. Muscle and bone mass loss in the elderly population:advances in diagnosis and treatment[J]. J Biomed (Syd), 2018, 3: 40-49.
23
Bahia MT, Hecke MB, Mercuri E. Image-based anatomical Reconstruction and pharmaco-mediated bone remodeling model applied to a femur with subtrochanteric fracture: A subject-specific finite element study[J]. Med Eng Phys, 2019, 69: 58-71.
24
Parker MJ, Bowers TR, Pryor GA. Sliding hip screw versus theTargon PF nail in the treatment of trochanteric fractures of the hip[J]. J Bone Joint Surg Br Vol, 2012, 94(3): 391-397.
25
Xu BY, Yan S, Low LL, et al. Predictors of poor functional outcomes and mortality in patients with hip fracture: a systematic review. BMC Musculoskelet Disord. 2019, 20(1):568
26
Choi H, Yoo J I. Sarcopenia and Hip-Structure-Analysis Variables in Korean Elderly Population[J]. Journal of Clinical Densitometry[J]. Journal of Clinical Densitometry, 2020, 23(3): 482-489.
27
Girgis CM. Integrated therapies for osteoporosis and sarcopenia: from signaling pathways to clinical trials[J]. Calcif Tissue Int, 2015, 96(3): 243-255.
28
Testa G, Vescio A, Zuccalà D, et al. Diagnosis, treatment and prevention of sarcopenia in hip fractured patients: where we are and where we are going: a systematic review[J]. J Clin Med, 2020, 9(9): 2997.
29
Avola M, Testa G, Mangano S, et al. Clinical Medicine Rehabilitation Strategies for Patients with Femoral Neck Fractures in Sarcopenia: A Narrative Review[J]. Journal of Clinical Medicine, 2020, 9(10): 3115.
30
Odvina CV, Zerwekh JE, Rao DS, et al. Severely suppressed bone turnover: a potential complication of alendronate therapy[J]. J Clin Endocrinol Metab, 2005, 90(3): 1294-1301.
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