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  • Title: [Effectiveness of proximal femoral nail anti-rotation combined with minimally invasive percutaneous plate osteosynthesis versus Intertan intramedullary nail fixation in treatment of intertrochanteric fracture with incomplete lateral wall].
    Author: Chen Z, Hu C, Zheng Z, Jiang H, Gao M, Wu B, Huang G, Ding Z.
    Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2020 Sep 15; 34(9):1085-1090. PubMed ID: 32929898.
    Abstract:
    OBJECTIVE: To compare the effectiveness of proximal femoral nail anti-rotation (PFNA) combined with minimally invasive percutaneous plate osteosynthesis (MIPPO) and Intertan intramedullary nail fixation by closed reduction in the treatment of AO/Orthopaedic Trauma Association (AO/OTA) type 31-A3.3 intertrochanteric fracture with incomplete lateral wall. METHODS: The clinical data of 54 patients with AO/OTA type 31-A3.3 intertrochanteric fracture who met the selection criteria and were admitted between January 2012 and January 2018 were retrospectively analyzed. According to different surgical methods, the patients were divided into group A (24 cases with lateral wall reconstruction by MIPPO combined with PFNA internal fixation) and group B (30 cases with Intertan intramedullary nail fixation by closed reduction only). There was no significant difference between the two groups ( P>0.05) in terms of gender, age, side of injury, cause of injury, and combined medical diseases. The operation time, intraoperative blood loss, time to weight-bearing, fracture healing time, and postoperative complications were recorded and compared between the two groups. The tip apex distance (TAD) was measured at 2 days, 2 months, and 1 year after operation. At 12 months after operation, the hip joint function was evaluated according to Harris scoring standard, and the rate of conformity (Harris score were more than 70) was calculated. RESULTS: The wounds of the two groups healed by first intention, without infection, skin deformity, and other incision complications. The operation time and intraoperative blood loss of group A were significantly more than those of group B, and the time to weight-bearing and fracture healing were significantly shorter than those of group B ( P<0.05). The patients were followed up 9-20 months (mean, 14.7 months) in group A and 9-19 months (mean, 13.8 months) in group B. There was no significant difference in TAD values at 2 days, 2 months, and 1 year after operation between the two groups ( P<0.05), and there was also no significant difference in TAD values between the postoperative time points ( P>0.05). There was 1 case of infection, 1 case of screw withdrawal, 2 cases of screw removal, and 1 case of bone nonunion in group B, the incidence of complications was 16.7%; there was only 1 case of screw withdrawal combined with screw blade withdrawal in group A, the incidence of complications was 4.2%; there was no significant difference between the two groups ( χ 2=2.109, P=0.146). At 12 months after operation, the Harris scores of pain, function, malunion, range of motion, and total score in group A were significantly better than those in group B ( P<0.05). The rate of conformity of group A was 95.83% (23/24) and 76.67% (23/30) in group B, and the difference between the two groups was significant ( χ 2=3.881, P=0.049). CONCLUSION: For the AO/OTA type 31-A3.3 intertrochanteric fracture with incomplete lateral wall, compared with the closed reduction Intertan intramedullary nail fixation, the incidence of internal fixation failure after MIPPO reconstruction with lateral wall combined with PFNA fixation was lower, the time to weight-bearing was earlier, and the postoperative function was better. 目的: 比较微创经皮钢板固定技术（minimally invasive percutaneous plate osteosynthesis，MIPPO）重建外侧壁联合股骨近端防旋髓内钉（proximal femoral nail anti-rotation，PFNA）固定与单纯闭合复位 Intertan 髓内钉固定治疗外侧壁不完整的国际内固定研究协会/美国骨创伤协会（AO/OTA）31-A3.3 型股骨转子间骨折临床疗效。. 方法: 回顾分析 2012 年 1 月—2018 年 1 月收治的 54 例符合选择标准的 AO/OTA 31-A3.3 型股骨转子间骨折患者临床资料。根据手术方式不同分为 A 组（锁定钢板 MIPPO 重建外侧壁联合 PFNA 内固定，24 例）和 B 组（单纯闭合复位 Intertan 髓内钉内固定，30 例）。两组患者性别、年龄、受伤侧别、致伤原因及合并内科疾病等一般资料比较差异均无统计学意义（ P>0.05）。记录并比较两组患者手术时间、术中出血量、术后开始下地时间、骨折愈合时间及术后并发症。术后 2 d、2 个月及 1 年测量尖顶距（tip apex distance，TAD）。术后 12 个月根据 Harris 评分标准评价髋关节功能，并计算合格率（Harris 评分>70 分）。. 结果: 两组患者切口均Ⅰ期愈合，无感染等切口并发症发生。A 组手术时间、术中出血量明显多于 B 组，术后开始下地时间、骨折愈合时间明显少于 B 组（ P<0.05）。所有患者均获随访，随访时间 A 组 9～20 个月，平均 14.7 个月；B 组 9～19 个月，平均 13.8 个月。两组间术后 2 d、2 个月及 1 年 TAD 值比较差异均无统计学意义（ P>0.05）；组内术后各时间点间 TAD 值比较差异亦无统计学意义（ P>0.05）。术后 B 组出现 1 例感染、1 例退钉、2 例螺钉切出、1 例骨不连，并发症发生率为 16.7%；A 组仅出现 1 例退钉合并螺旋刀片退出，并发症发生率为 4.2%；两组并发症发生率比较差异无统计学意义（ χ 2=2.109， P=0.146）。术后 12 个月，A 组 Harris 评分的疼痛、功能、畸形和关节活动度评分及总分均明显优于 B 组（ P<0.05）。其中 A 组合格率为 95.83%（23/24），B 组合格率为 76.67%（23/30），两组合格率比较差异有统计学意义（ χ 2=3.881， P=0.049）。. 结论: 针对外侧壁不完整的 AO/OTA 31-A3.3 型股骨转子间骨折，与单纯闭合复位 Intertan 髓内钉固定相比，MIPPO 重建外侧壁联合 PFNA 固定术后内固定失效发生率更低，患者术后开始下地时间更早，术后功能恢复更好。.
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