不同体位下PFNA治疗高龄股骨粗隆间骨折疗效比较

PFNA in Different Position for the Treatment of Elderly Patients with Femoral Intertrochanteric Fractures

目的探讨仰卧位和侧卧位下行股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)治疗EvansⅡ~Ⅲ型高龄股骨粗隆间骨折的临床疗效及差异。方法研究对象选取我院2012年4月至2015年4月收治EvansⅡ~Ⅲ型高龄股骨粗隆间骨折共120例,以随机区组法分为A组(60例)和B组(60例),分别在仰卧位和侧卧位下行PFNA治疗,比较两组患者围手术期临床指标水平、术后髋关节Harris评分优良率及术后并发症发生率。结果B组患者切口长度、手术时间及术中失血量均显著优于A组,差异具有统计学意义(P<0.05);A组患者术中X线透视剂量显著低于B组,差异具有统计学意义(P<0.05);两组骨折愈合时间比较差异无统计学意义(P>0.05);两组患者术后髋关节Harris评分优良率比较差异无统计学意义(P>0.05);两组患者术后并发症发生率比较差异无统计学意义(P>0.05)。结论仰卧位和侧卧位下行PFNA治疗EvansⅡ~Ⅲ型高龄股骨粗隆间骨折在促进术后髋关节功能恢复方面效果接近,且无严重术后并发症发生;侧卧位下行PFNA可有效减少术中创伤,缩短手术时间,但术中辐射量较仰卧位增加。

Objective To investigate the PFNA in supine position and lateral decubitus position for the treatment of elderly patients with femoral intertrochanteric fractures for EvansⅡ-Ⅲtype.Methods 120 elderly patients with femoral intertrochanteric fractures for EvansⅡ-Ⅲtype were chosen in the period from April 2010 to April 2013 in our hospital and randomly divided into both group including A group（60patients）with PFNA in supine position and B group（60patients）with PFNA in lateral decubitus position;and the peri-operative indexes levels,the excellent and good rate of Harris scores postoperative for hip joint function and postoperative complication incidence of both groups were compared.Results The incision length,operative time and intraoperative blood loss of B group was significantly better than A group（P〈0.05）.The intraoperative X-ray dose of A group was significantly better than B group（P〈0.05）.There was no significant difference in fracture healing time between 2groups（P〉0.05）.There was no significant difference in the excellent and good rate of Harris scores postoperative for hip joint function between 2groups（P〉0.05）.There was no significant difference in the postoperative complication incidence between 2groups（P〉0.05）.Conclusion PFNA including supine position and lateral decubitus position in the treatment of elderly patients with femoral intertrochanteric fractures for EvansⅡ-Ⅲtype possess the same effect to promote recovery process of hip joint function and not induce the serious postoperative complication;PFNA in the lateral decubitus position application can efficiently reduce the trauma degree in the operation and shorten the operation time,but increase the intraoperative X-ray dose.