摘要
目的比较侧卧位与半截石卧位下应用亚洲型股骨近端防旋髓内钉(PFNA-Ⅱ)内固定治疗老年股骨转子间骨折的疗效。方法采用回顾性病例对照研究分析2016年1月—2017年9月重庆市江津区中心医院收治的141例股骨转子间骨折患者临床资料,其中男54例,女87例;年龄65~99岁,平均80.4岁。骨折AO分型:A1型42例,A2型88例,A3型11例。74例采用侧卧位行PFNA-Ⅱ内固定治疗(侧卧位组),67例采用半截石卧位行PFNA-Ⅱ内固定治疗(半截石卧位组)。比较两组体位摆放时间、切口总长度、手术时间、术中出血量、透视次数、尖顶距、骨折复位质量、骨折愈合时间、术后并发症情况及术后12个月髋关节功能Harris评分。结果除13例术后9个月随访后失访,其余患者均获随访12~18个月,平均12.5个月。两组体位摆放时间、手术时间、骨折愈合时间、髋关节功能Harris评分比较差异均无统计学意义(P>0.05)。切口总长度:侧卧位组为(6.5±1.3)cm,半截石卧位组为(7.5±1.5)cm;术中出血量:侧卧位组为(84.3±3.1)ml,半截石卧位组为(90.4±3.9)ml;透视次数:侧卧位组为(13.1±1.9)次,半截石卧位组为(11.2±1.2)次;尖顶距:侧卧位组为(20.6±2.2)mm,半截石卧位组为(24.4±1.8)mm;骨折复位质量优良率:侧卧位组为80%,半截石卧位组为85%;内置物相关并发症发生率:侧卧位组为5%,半截石卧位组为2%(P均<0.05或0.01)。结论与侧卧位比较,半截石卧位行PFNA-Ⅱ内固定治疗老年股骨转子间骨折可减少透视次数,提高骨折复位质量,减少内置物相关并发症。
Objective To compare the therapeutic effect of lateral position and half lithotomy position in Asian proximal femur intramedullary nail antirotation system(PFNA-Ⅱ)for treating the elderly patients with femoral intertrochanteric fractures.Methods A retrospective case control study was made on 141 patients with femoral intertrochanteric fractures admitted to Jiangjin Central Hospital from January 2016 to September 2017,including 54 males and 87 females,aged 65-99 years(mean,80.4 years).According to AO classification,there were 42 patients with type A1 fractures,88 with type A2 and 11 with type A3.Of all,74 patients were stabilized by PFNA-Ⅱ internal fixation in lateral position(lateral position group)and 67 patients by PFNA-Ⅱ internal fixation in half lithotomy position(half lithotomy position group).The postural placement time,total incision length,operative time,intraoperative blood loss,fluoroscopy frequency,tip-apex distance,reduction quality,fracture healing time,postoperative complications and Harris hip function at 12 months after surgery were compared between the two groups.Results All patients were followed up for 12-18 months(mean,12.5 months),except that 13 patients were lost after 9 months,an average of 12.5 months.There were no statistically significant differences in postural placement time,operative time,fracture healing time,and Harris hip score between the two groups(P>0.05).While significant differences were seen between lateral position group and half lithotomy position group regarding the incision length[(6.5±1.3)cm vs.(7.5±1.5)cm],intraoperative blood loss[(84.3±3.1)ml vs.(90.4±3.9)ml],fluoroscopy frequency[(13.1±1.9)times vs.(11.2±1.2)times],tip-apex distance[(20.6±2.2)mm vs.(24.4±1.8)mm],good rate of reduction quality(80%vs.85%)and implant related complications(5%vs.2%)(P<0.05 or 0.01).Conclusion For treatment of elderly patients with intertrochanteric fractures,compared to the lateral position,the half lithotomy position in PFNA-II internal fixation can reduce frequency of fluoroscopy,improve quality of fracture reduction and reduce implant-related complications.
作者
张孝华
周述清
杨博文
余璐鑫
朱明
廖友鑫
叶健
朱秋汶
Zhang Xiaohua;Zhou Shuqing;Yang Bowen;Yu Luxin;Zhu Ming;Liao Youxin;Ye Jian;Zhu Qiuwen(Department of Orthopedics,Jiangjin Central Hospital,Chongqing 402260,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2020年第6期503-508,共6页
Chinese Journal of Trauma
关键词
股骨骨折
骨折固定术
髓内
老年人
侧卧位/半截石卧位
Femoral fractures
Fracture fixation
intramedullary
Aged
Lateral position/half lithotomy position
