实用老年医学 ›› 2025, Vol. 39 ›› Issue (5): 519-523.doi: 10.3969/j.issn.1003-9198.2025.05.017

• 临床研究 • 上一篇    下一篇

InterTAN髓内钉治疗股骨转子间骨折术后即刻负重及早期行走的效果

李传平, 陈文华, 余波, 尹刚, 严善钟   

  1. 200080 上海市,上海市第一人民医院康复医学科(李传平,陈文华,余波,严善钟);骨科(尹刚)
  • 收稿日期:2024-07-29 出版日期:2025-05-20 发布日期:2025-05-20
  • 通讯作者: 严善钟,Email:yanshanzhong@163.com

Effect of immediate weight-bearing and early ambulation for intertrochanteric fractures after InterTAN nail surgery

LI Chuanping, CHEN Wenhua, YU Bo, YIN Gang, YAN Shanzhong   

  1. Department of Rehabilitation & Orthopedics, Shanghai General Hospital, Shanghai 200080, China
  • Received:2024-07-29 Online:2025-05-20 Published:2025-05-20
  • Contact: YAN Shanzhong, Email: yanshanzhong@163.com

摘要: 目的 观察InterTAN髓内钉治疗股骨转子间骨折术后即刻负重及早期行走的康复疗效。 方法 将2023年3月至2024年1月61例JensenⅡ型股骨转子间骨折行InterTAN髓内钉术且骨折复位满足股骨近端内侧骨皮质阳性支撑(positive medial cortex support,PMCS)的病人随机分成对照组31例和试验组30例。对照组于术后6周行负重及行走训练,试验组于术后48 h内行负重及行走训练。统计2组住院时间、住院费用、骨折临床愈合时间和术后3个月并发症发生率,采用Harris髋关节评分(Harris Hip Score,HHS)和VAS评分分别于术后2 d和3个月进行评估。 结果 在治疗和随访阶段,2组各脱落3例,最终纳入55例病人。2组年龄、性别、BMI等一般资料差异无统计学意义(P>0.05)。术后2 d和3个月,2组间VAS评分差异均无统计学意义(P>0.05)。试验组住院时间、骨折临床愈合时间明显短于对照组,住院费用明显低于对照组,差异均有统计学意义(P<0.05)。2组术后2 d HHS评分差异无统计学意义(P>0.05),术后3个月2组HHS评分均高于术后2 d(P<0.01),且试验组明显高于对照组(P<0.05)。2组并发症发生率差异无统计学意义(17.9%比3.7%,χ2=2.833,P=0.092)。 结论 JensenⅡ型股骨转子间骨折行InterTAN髓内钉术,且骨折复位满足股骨近端PMCS的病人,术后48 h内行可耐受即刻负重及早期行走,可降低住院费用、缩短住院时间、加快骨折愈合和髋关节功能恢复,且不加重术后疼痛和内固定失败率。

Abstract: Objective To observe the effect of immediate weight-bearing and early ambulation for intertrochanteric fractures after InterTAN nail surgery. Methods From March 2023 to January 2024, a total of 61 patients diagnosed with Jensen type Ⅱ intertrochanteric fractures and postoperative reduction as positive medial cortical support (PMCS) after InterTAN nail surgery were randomly divided into control group (n=31) and experimental group (n=30). The control group was allowed to weight-bearing and ambulation as tolerated 6 weeks after surgery, while the experimental group was allowed to weight-bearing and ambulation within 48 hours after surgery. The length of stay, hospitalization costs, time of clinical fracture healing and the incidence rate of complications 3 months after surgery were recorded. Harris Hip Score(HHS) and Visual Analog Scale (VAS) were evaluated regularly 2 days and 3 months after surgery. Results During the treatment and follow-up stages, 3 patients dropped out from each group, resulting in a final total of 55 patients being included. There was no statistically significant difference in general information such as age, gender and body mass index between the two groups (P>0.05). There were no significant differences in VAS scores between the two groups 2 days and 3 months after surgery (P>0.05). Compared with the control group, the length of stay and time of clinical fracture healing were shorter, and hospitalization costs were lower in the experimental group, with significant differences (P<0.05). There was no statistically significant difference in HHS score between the two groups 2 days after surgery (P>0.05). HHS scores in both groups 3 months after surgery showed significant improvement compared to those 2 days after surgery (P<0.01), especially in the experimental group (P<0.05). There were no significant differences in the incidence rate of complications between the two groups (17.9% vs 3.7%, χ2=2.833, P=0.092). Conclusions Immediate weight-bearing and early ambulation as tolerated within 48 hours for patients with Jensen type Ⅱ intertrochanteric fractures and postoperative reduction with PMCS after InterTAN nail surgery could shorten the length of stay, reduce hospitalization costs, promote fracture healing and recovery of hip function, without increasing postoperative pain and the failure rate of internal fixation.