The effect of Asian-type PFNA on the joint function and complications in elderly patients with intertrochanteric fracture of femur

doi:10.3877/cma.j.issn.2096-0263.2021.03.005

Abstract

Abstract:

Objective

To discuss the effect of Asian-type proximal femora l anti-rotation intramedullary nail (PFNA) on the joint function and complications in elderly patients with intertrochanteric fracture of femur (IFF).

Methods

The 160 elderly patients with IFF in our hospital from June 2016 to June 2018 were selected, they were divided into PFNA-Ⅱ group and traditional PFNA group, 80 cases in each group. The PFNA-Ⅱ group was treated with PFNA-Ⅱ, 50 males and 30 females, aged (70±6) years. The traditional PFNA group was treated with traditional PFNA, 46 males and 34 females, aged (69±5) years. The joint function, complications, operation and rehabilitation of the two groups were followed and compared.

Results

The 160 patients were followed up completely, the follow-up time was (16.4±2.8) months. There was no significant difference in the incision length and the time of partial weight-bearing, complete weight-bearing, fracture healing between the traditional PFNA group and PFNA-Ⅱ group (P>0.05), and the intraoperative bleeding volume [(92±10)ml] and the time of operation [(59±6)min], fluoroscopy [(2.7±0.4)min], hospitalization [(6.2±0.7)d] in the PFNA-Ⅱ group were significantly lower than those in the traditional PFNA group [(112±14)ml, (59±6)min, (3.4±0.5)min, (7.5±0.9)d], the difference was statistically significant (t=10.276, t=8.946, t=8.748, t=10.442, all P<0.05). The complication rate in the PFNA-Ⅱ group (7.50%) was significantly lower than that in the traditional PFNA group (22.50%), the difference was statistically significant (χ²=7.059, P<0.05). There was no significant difference in joint function excellent rates between the traditional PFNA group and PFNA-Ⅱ group (90.00%, 95.00% vs 85.00%, 92.50%) at 6 and 12 months after operation (P>0.05).

Conclusions

Asian-type PFNA can also effectively improve joint function of elderly patients with IFF, and it can effectively reduce surgical trauma and complications, which is helpful to improve the physical rehabilitation of patients, it's worth for further clinical promotion.

Key words: Aged, Hip fractures, Joint function, Complications

Lei Wang, Lei Gao. The effect of Asian-type PFNA on the joint function and complications in elderly patients with intertrochanteric fracture of femur[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2021, 07(03): 152-157.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhlngkykfdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-0263.2021.03.005

https://zhlngkykfdzzz.cma-cmc.com.cn/EN/Y2021/V07/I03/152

Figures/Tables 7

References 23

1	陈明，曹奇圣，王力，等. 加速康复外科理念下多模式镇痛在老年股骨转子间骨折治疗中的应用[J]. 中华老年骨科与康复电子杂志，2019，5(1)：4-8.
2	Li J, Cheng L, Jing J. The Asia proximal femoral nail antirotation versus the standard proximal femoral antirotation nail for unstable intertrochanteric fractures in elderly Chinese patients [J]. Orthop Traumatol Surg Res, 2015, 101(2): 143-146.
3	王虎，李明，靳泽岳，等. 不同方法治疗老年股骨转子间合并转子下骨折的比较[J]. 中华老年骨科与康复电子杂志，2019，5(3)：135-142.
4	Rui Z, Yang ZQ, Tao L, et al. Effects of aminocaproic acid on perioperative hidden blood loss in elderly patients with femoral intertrochanteric fracture treated with proximal femoral nail anti-rotation [J]. J Int Med Res, 2019, 47(10): 5010-5018.
5	Zhang R, Yang Z, Lei T, et al. Effects of aminocaproic acid on perioperative hidden blood loss in elderly patients with femoral intertrochanteric fracture treated with proximal femoral nail anti-rotation [J]. J Int Med Res, 2019, 47(10):5010-5018.
6	Li JT, Lin H, Hao Z, et al. Medial sustainable nail versus proximal femoral nail antirotation in treating AO/OTA 31-A2.3 fractures: Finite element analysis and biomechanical evaluation [J]. Injury, 2019, 50(3): 648-656.
7	侯建伟，谢仁国，李玉前，等. 加长型PFNA-Ⅱ和DHS治疗老年骨质疏松性股骨转子下骨折的疗效分析[J]. 中华老年骨科与康复电子杂志，2017，3(1)：22-26.
8	Zeng XS, Zhang N, Zeng D, et al. Proximal femoral nail antirotation versus dynamic hip screw fixation for treatment of osteoporotic type 31-A1 intertrochanteric femoral fractures in elderly patients [J]. J Int Med Res, 2017, 45(3): 1109-1123.
9	胡建平，李俊峰，秦鸿雁，等. 长短髓内钉治疗老年股骨反转子间骨折的疗效比较[J]. 中华老年骨科与康复电子杂志，2019，5(3)：143-148.
10	Jiamton C, Katja B, Babst R, et al. The nail-shaft-axis of the of proximal femoral nail antirotation (PFNA) is an important prognostic factor in the operative treatment of intertrochanteric fractures [J]. Arch Orthop Trauma Surg, 2018, 138(3): 339-349.
11	卢冰，王跃，刘攀，等. 髓内钉及动力髋螺钉治疗老年稳定性股骨转子间骨折的比较[J]. 中华老年骨科与康复电子杂志，2017，3(5)：260-264.
12	Wang C, Wang Q. Helical blade compression failure occurred during PFNA implantation: A rare case and ingenious solution [J]. Medicine (Baltimore), 2019, 98(30):e16584.
13	Kammerlander C, Einar SH, Klopfer T, et al. Cement augmentation of the Proximal Femoral Nail Antirotation (PFNA) - A multicentre randomized controlled trial [J]. Injury, 2018, 49(8): 1436-1444.
14	Kang Y, Liu J, Chen H, et al. Enhanced recovery after surgery (ERAS) in elective intertrochanteric fracture patients result in reduced length of hospital stay (LOS) without compromising functional outcome [J]. J Orthop Surg Res, 2019, 14(1):209.
15	Hong JB, Dan Y, Ouyang L, et al. Biomechanical study on different lengths of PFNA fixation for unstable intertrochanteric femoral fractures [J]. J Musculoskelet Neuronal Interact, 2017, 17(4): 299-302.
16	Xie Y, Dong Q, Xie Z. Proximal femoral nail anti-rotation (PFNA) and hemi-arthroplasty in the treatment of elderly intertrochanteric fractures [J]. Acta Orthop Belg, 2019, 85(2):199-204.
17	Wang Q, Gu XH, Li X, et al. Management of low-energy basicervical proximal femoral fractures by proximal femoral nail anti-rotation [J]. Orthop Surg, 2019, 11(6):1173-1179.
18	Sharma A, Sethi A, Sharma S. Treatment of stable intertrochanteric fractures of the femur with proximal femoral nail versus dynamic hip screw: a comparative study [J]. Rev Bras Ortop, 2017, 53(4):477-481.
19	Yam M, Chawla A, Kwek E. Rewriting the tip apex distance for the proximal femoral nail anti-rotation [J]. Injury, 2017, 48(8):1843-1847.
20	Wang W, Zhai S, Han XP, et al. [Comparative study of proximal femoral nail anti-rotation and dynamic hip screw in the unstable intertrochanteric fractures in the elderly [J]. Zhonghua Yi Xue Za Zhi, 2018, 98(5):357-361.
21	Csonka Á, Ecseri T, Dózsai D, et al. The prognostic value of the hip screw position in intertrochanteric fractures [J]. Orv Hetil, 2019, 160(9):338-342.
22	Yang X, Wu Q, Wang X. Investigation of perioperative hidden blood loss of unstable intertrochanteric fracture in the elderly treated with different intramedullary fixations [J]. Injury, 2017, 48(8):1848-1852.
23	Li H, Zhang W, Yan J, et al. Greater trochanter of the femur(GTF) vs. proximal femoral nail anti-rotation(PFNA) for unstable intertrochanteric femoral fracture [J]. Eur Rev Med Pharmacol Sci, 2018, 22(1 Suppl): 8-14.

组别	例数	性别（例，男/女）	AO分型（例，A1/A2/A3）	伤因（例，交通/高坠/碰摔）	年龄（岁，±s）	就诊时间（h，±s）	身体质量指数（kg/m²，±s）
传统型PFNA组	80	46/34	28/36/16	20/44/16	69±5	7.5±0.9	22.3±2.4
PFNA-Ⅱ组	80	50/30	30/32/18	22/40/18	70±6	7.6±0.9	22.5±2.4
统计值		χ²=0.417	χ²=0.422	χ²=0.403	t=0.774	t=0.550	t=0.585
P值		0.519	0.516	0.525	0.440	0.583	0.560

组别	例数	性别（例，男/女）	AO分型（例，A1/A2/A3）	伤因（例，交通/高坠/碰摔）	年龄（岁，±s）	就诊时间（h，±s）	身体质量指数（kg/m²，±s）
传统型PFNA组	80	46/34	28/36/16	20/44/16	69±5	7.5±0.9	22.3±2.4
PFNA-Ⅱ组	80	50/30	30/32/18	22/40/18	70±6	7.6±0.9	22.5±2.4
统计值		χ²=0.417	χ²=0.422	χ²=0.403	t=0.774	t=0.550	t=0.585
P值		0.519	0.516	0.525	0.440	0.583	0.560

组别	例数	切口长度（cm）	术中出血量（ml）	手术时间（min）	透视时间（min）
传统型PFNA组	80	4.3±0.5	112±14	68±7	3.4±0.5
PFNA-Ⅱ组	80	4.4±0.6	92±10	59±6	2.7±0.4
t值		0.790	10.276	8.946	8.748
P值		0.431	<0.001	<0.001	<0.001

组别	例数	切口长度（cm）	术中出血量（ml）	手术时间（min）	透视时间（min）
传统型PFNA组	80	4.3±0.5	112±14	68±7	3.4±0.5
PFNA-Ⅱ组	80	4.4±0.6	92±10	59±6	2.7±0.4
t值		0.790	10.276	8.946	8.748
P值		0.431	<0.001	<0.001	<0.001

组别	例数	住院时间（d）	部分负重时间（周）	完全负重时间（周）	骨折愈合时间（周）
传统型PFNA组	80	7.5±0.9	7.6±1.1	12.2±1.6	14.3±1.8
PFNA-Ⅱ组	80	6.2±0.7	7.4±1.1	12.0±1.5	14.0±1.8
t值		10.442	1.049	0.857	0.795
P值		<0.001	0.296	0.393	0.428

Please choose a citation manager

Content to export