摘要
目的:探讨自主研发的解剖型主钉置入导向器在股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定治疗老年股骨转子间骨折(intertrochanteric fracture,IFF)中的应用效果。方法:回顾性分析2022年1月至2024年12月符合纳入标准的62例AO31-A2型股骨转子间骨折进行PFNA手术患者,分为使用常规方法置入PFNA(常规操作组)和使用解剖型主钉置入导向器辅助置入PFNA(导向器组)。常规操作组31例,男14例,女17例,年龄64~90(75.2±11.6)岁。导向器组31例,男10例,女21例,年龄67~97(78.6±13.4)岁。观察比较两组主钉入口切口长度、复位满意到置入主钉前透视次数、手术时间、术中出血量、术后3 d疼痛视觉模拟评分(visual analogue scale,VAS)、术后髋关节功能Harris评分、并发症等情况。结果:患者均获得随访,时间4~12(6.8±1.6)个月。常规操作组与导向器组比较,主钉入口切口长度[(6.74±3.77)cm vs.(5.13±1.31)cm]、复位满意到置入主钉前透视次数[(10.32±3.08)次vs.(7.71±2.41)次]、手术时间[(150.45±53.47)min vs.(127.48±30.37)min]、术中出血量[(196.77±121.06)ml vs.(140.97±86.00)ml],差异均有统计学意义(P<0.05)。两组术后3 d的VAS比较,差异无统计学意义(P>0.05)。术后1个月常规操作组与导向器组髋关节Harris评分[(60.61±6.60)分vs.(65.48±5.19)分]比较,差异有统计学意义(P<0.05),术后3个月两组髋关节Harris评分比较差异无统计学意义(P>0.05)。术后两组随访3个月均未出现切口感染、螺钉松动、切割、压疮及深静脉血栓等并发症。结论:AO31-A2型股骨转子间骨折患者使用PFNA解剖型主钉置入导向器可快速精准置入导针,缩短手术时间,减少手术创伤及X线辐射损伤,利于老年股骨转子间骨折患者的快速康复。
Objective To explore the application effect of self-developed anatomical main nail insertion guide in proximal femoral nail antirotation(PFNA)internal fixation for the treatment of intertrochanteric fractures(IFF)in elderly patients.Methods A retrospective analysis was performed on 62 patients with AO31-A2 intertrochanteric fractures who underwent PFNA surgery and met the inclusion criteria from January 2022 to December 2024.They were divided into the conventional PFNA insertion group(conventional operation group)and the anatomical main nail insertion guide-assisted PFNA insertion group(guide group).The conventional operation group(PFNA)included 31 patients,14 males and 17 females,the age ranged from 64 to 90 with an average of(75.2±11.6)years old;the guide group(PFNA)included 31 patients,10 males and 21 females,the age ranged fron 67 to 97 with an average of(78.6±13.4)years old.The incision length of the main nail entry,the number of fluoroscopies from satisfactory reduction to before main nail insertion,operation time,intraoperative blood loss,3-day postoperative VAS score,postoperative hip function Harris score,complications,etc.were observed and compared between the two groups.Results All patients were followed up for a period ranging from 4 to 12 months,with an average follow-up duration of(6.8±1.6)months.Compared with the guide group,the conventional operation group showed significant differences in the following parameters:the entrance length of the main screw was(6.74±3.77)cm vs.(5.13±1.31)cm,the number of fluoroscopies before the insertion of the main screw was(10.32±3.08)times vs.(7.71±2.41)times,the operation time was(150.45±53.47)minutes vs.(127.48±30.37)minutes,and the intraoperative blood loss was(196.77±121.06)ml vs.(140.97±86.00)ml,with P<0.05 indicating statistical significance.There was no statistically significant difference in 3-day postoperative VAS between the two groups(P>0.05).There was a statistically significant difference in the Harris scores between the conventional operation group and the guided operation group one month post-surgery(60.61±6.60)vs.(65.48±5.19)points(P<0.05).and there was no statistically significant difference in hip Harris scores between the two groups at 3 months after operation(P>0.05).During the 3-month follow-up after operation,neither group had incision infection,screw loosening,cutting,pressure sores,deep vein thrombosis,etc.,and there was no statistically significant difference in the complication rate between the two groups.Conclusion It is quickly and accurately to implant PFNA assisted by the anatomical major nail implant guide in treatment of osteoporotic intertrochanteric fracture in the elderly.Compared with the traditional operation,it can shorten the operation time and reduce the surgical and X-ray trauma,and beneficial to the rapid rehabilitation of patients.
作者
杨雨鑫
徐顺利
王鑫
张成祺
管凯
YANG Yu-xin;XU Shun-li;WANG Xin;ZHANG Cheng-qi;GUAN Kai(The Fifth Clinical College of Xinxiang Medical University,Xinxiang 453003,Henan,China;Department of Orthopaedics,Xinxiang First People's Hospital,Xinxiang 453000,Henan,China)
出处
《中国骨伤》
2025年第7期668-675,共8页
China Journal of Orthopaedics and Traumatology
