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目的 探讨不同长度股骨近端防旋髓内钉(PFNA)主钉治疗31-A3.1～A3.3型股骨转子间骨折(IFF)患者的效果。方法 选取2022年9月至2024年10月收治的150例31-A3.1～A3.3型IFF患者进行前瞻性研究。随机数字表法分为长钉组、短钉组各75例。长钉组PFNA选择加长型主钉，短钉组PFNA选择普通型主钉。比较两组围术期指标、骨折愈合时间、完全负重时间、住院时间，复位质量、术后稳定性、手术创伤应激因子[超氧化物歧化酶(SOD)、血管紧张素Ⅱ(AngⅡ)、去甲肾上腺素(NE)]水平、髋关节活动度[髋伸屈活动度(ROM)、髋内-外旋ROM]、髋关节功能及并发症。结果 相较于短钉组，长钉组患者手术时间、住院时间较长，失血量、术中X线透视次数较多，完全负重时间、骨折愈合时间较短(P<0.05)；两组患者复位质量比较差异无统计学意义(P>0.05)；长钉组患者术后稳定性优于短钉组(P<0.05)；长钉组患者术后1、3 d SOD低于短钉组，AngⅡ、NE高于短钉组(P<0.05)；术后3、6个月两组髋伸屈、髋内-外旋ROM比较差异无统计学意义(P>0.05)；长钉组髋关节功能优良率[98.67%(74/75)]较短钉组[89.33%(67/75)]高(P<0.05)；长钉组并发症总发生率[1.33%(1/75)]与短钉组[2.67%(2/75)]比较差异无统计学意义(P>0.05)。结论 与普通型PFNA主钉相比，采用加长型PFNA主钉治疗31-A3.1～A3.3型IFF患者能促进骨折愈合，提高术后稳定性，改善患者髋关节功能，安全性良好，但创伤较大，围术期恢复较慢。
Abstract：Objective To investigate the effect of different main nail lengths of the proximal femoral nail antirotation(PFNA) in the treatment of patients with type 31-A3.1-A3.3 intertrochanteric femoral fracture(IFF). Methods A prospective study was conducted on 150 patients with type 31-A3.1-A3.3 IFF admitted from September 2022 to October 2024. These patients were divided into a long nail group and a short nail group based on a random number table method, with 75 patients in each group. The long nail group received the extended-length main nail for PFNA, while the short nail group received the standard-length main nail for PFNA. The perioperative indicators, fracture healing time, duration of complete weight-bearing, duration of operation, reduction quality, postoperative stability, surgical trauma stress factors [superoxide dismutase(SOD), angiotensin Ⅱ(AngⅡ), norepinephrine(NE)], hip joint mobility [hip flexion-extension range of motion(ROM), internal-external rotation ROM of the hip], hip joint function, and complications were compared between the two groups. Results Compared with the short nail group, the duration of operation, length of hospitalization, blood loss, and intraoperative fluoroscopy frequency of the long nail group were longer or more, while duration of complete weight-bearing and fracture healing time were shorter(P<0.05). There was no significant difference in the quality of reduction between the two groups(P>0.05). The postoperative stability of the long nail group was better than that of the short nail group(P<0.05). On the 1 st and 3 rd day after operation, SOD in the long nail group was lower than that in the short nail group, while Ang Ⅱ and NE were higher than those in the short nail group(P<0.05). There was no significant difference in hip flexion and hip internal-external rotation ROM between the two groups at 3 and 6 months after operation(P>0.05). The excellent and good rate of hip joint function in long nail group [98.67%(74/75)] was higher than that in short nail group [89.33%(67/75)](P<0.05). There was no significant difference in the total incidence of complications between the long nail group [1.33 %(1/75)] and the short nail group [2.67%(2/75)](P>0.05). Conclusion Compared with standard-length main nail for PFNA, the extended-length main nail for PFNA in the treatment of patients with type 31-A3.1-A3.3 type IFF can promote fracture healing, improve postoperative stability, improve hip function, and has good safety; however, it is associated with greater surgical trauma and a slower perioperative recovery.
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基本信息:
中图分类号:R687.3
引用信息:
[1]肖箫,刘帅印,张晓龙,等.PFNA主钉长度对31-A3.1～A3.3型股骨转子间骨折复位质量、手术创伤程度、术后稳定性的影响[J].临床误诊误治,2026,39(02):55-61.
基金信息:
维坊市科技发展计划项目（2022YX024）
2026-01-27
2026-01-27