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  • Title: [Treatment of AO/OTA type 31-A3 intertrochanteric fracture with proximal femoral nail antirotation combined with mini plate reconstruction of lateral femoral wall].
    Author: Li Y, Hu C, Mao L, Zhu Y, Cai X.
    Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2019 Oct 15; 33(10):1223-1227. PubMed ID: 31544429.
    Abstract:
    OBJECTIVE: To explore the effectiveness of proximal femoral nail antirotation (PFNA) combined with mini plate for reconstruction of lateral femoral wall in the treatment of type AO/Orthopaedic Trauma Association (AO/OTA) type 31-A3 intertrochanteric fracture. METHODS: The clinical data of 70 elderly patients with AO/OTA type 31-A3 intertrochanteric fracture treated between January 2013 and January 2018 were retrospectively analyzed. They were divided into group A (PFNA alone, 35 cases) and group B (PFNA combined with mini plate reconstruction of lateral femoral wall, 35 cases). There was no significant difference in the general data of gender, age, side, cause of injury, time from injury to operation between the two groups ( P>0.05). The operation time, intraoperative blood loss, fracture healing time, postoperative complications, and the tip apex distance (TAD) at 2 months after operation were recorded and compared between the two groups. Harris hip score was used to evaluate the function at 12 months after operation. RESULTS: Both groups were followed up 9-21 months, with an average of 16.6 months. The operation time and intraoperative blood loss in group A were significantly less than those in group B ( P<0.05); there was no significant difference in TAD between the two groups at 2 months after operation ( t=0.096, P=0.462). There were 5 complications (14.3%) occurred in group A, including 2 cases of blade perforating from the hip joint, 2 cases of screw back out, and 1 case of bone nonunion; only 1 case (2.9%) in group B had screw back out after operation; there was no significant difference in the incidence of complications between the two groups ( χ 2=2.917, P=0.088). All the fracture healed in group B, and 1 patient in group A suffered bone nonunion and eventually main nail fracture. The healing time of fracture in group A [(15.6±2.7) weeks] was significantly longer than that in group B [(12.5±2.5) weeks], showing significant difference ( t=2.064, P=0.023). At 12 months after operation, according to Harris score, the results were excellent in 5 cases, good in 9 cases, fair in 13 cases, and poor in 8 cases in group A, the qualified rate (Harris score>70) was 77.14%; and the results were excellent in 7 cases, good in 11 cases, fair in 16 cases, and poor in 1 case in group B, the qualified rate was 97.14%; there was significant difference in the qualified rate between the two groups ( χ 2=6.248, P=0.012). CONCLUSION: Compared with PFNA alone, the treatment of AO/OTA type 31-A3 intertrochanteric fracture with PFNA combined with mini plate reconstruction of lateral femoral wall can significantly reduce postoperative complications, promote fracture healing, and improve functional recovery of patients after operation. 目的: 探讨股骨近端防旋髓内钉（proximal femoral nail antirotation，PFNA）联合小钢板重建股骨外侧壁治疗国际内固定研究协会/美国骨创伤协会（AO/OTA）31-A3 型股骨转子间骨折的临床疗效。. 方法: 回顾分析 2013 年 1 月—2018 年 1 月收治的符合选择标准的 70 例老年 AO/OTA 31-A3 型股骨转子间骨折患者临床资料，根据是否重建外侧壁分为 A 组（PFNA 组，35 例）和 B 组（PFNA+小钢板重建外侧壁组，35 例）。两组患者性别、年龄、侧别、致伤原因、受伤至手术时间等一般资料比较差异均无统计学意义（ P>0.05），具有可比性。记录并比较两组患者手术时间、术中失血量、骨折愈合时间、术后并发症、术后 2 个月尖顶距（tip apex distance，TAD）值；术后 12 个月行 Harris 髋关节评分评价功能。. 结果: 两组患者均获随访，随访时间 9～21 个月，平均 16.6 个月。A 组手术时间和术中出血量均显著低于 B 组（ P<0.05）；两组术后 2 个月 TAD 比较差异无统计学意义（ t=0.096， P=0.462）。A 组术后有 5 例并发症（14.3%），包括螺旋刀片从髋关节穿出 2 例，退钉 2 例，骨不连 1 例；B 组仅 1 例（2.9%）发生术后退钉；两组并发症发生率比较差异无统计学意义（ χ 2=2.917， P=0.088）。B 组患者骨折均愈合，A 组 1 例发生骨折不愈合并最终主钉断裂，A 组骨折愈合时间（15.6±2.7）周明显长于 B 组的（12.5±2.5）周，差异有统计学意义（ t=2.064， P=0.023）。术后 12 个月根据 Harris 髋关节评分，A 组优 5 例、良 9 例、可 13 例、差 8 例，合格率（Harris 评分>70 分）为 77.14%；B 组优 7 例、良 11 例、可 16 例、差 1 例，合格率为 97.14%；两组合格率比较差异有统计学意义（ χ 2=6.248， P=0.012）。. 结论: 与单纯 PFNA 治疗相比，PFNA 结合小钢板重建股骨外侧壁治疗 AO/OTA 31-A3 型股骨转子间骨折，可显著减少术后并发症，促进骨折愈合，改善术后患者功能恢复。.
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