牵引床与手法牵引闭合复位PFNA内固定治疗老年股骨粗隆间骨折的比较

Analysis of clinical effect of using traction bed and manual traction in PFNA surgery for treatment of femoral intertrochanteric fractures in elderly patients

目的比较牵引床与手法牵引闭合复位股骨近端防旋髓内钉(PFNA)内固定治疗老年股骨粗隆间骨折的效果。方法纳入自2011-12—2016-12采用PFNA内固定治疗的38例老年股骨粗隆间骨折,19例采用手法牵引闭合复位PFNA内固定治疗(手法牵引组),19例采用牵引床闭合复位PFNA内固定治疗(牵引床组)。比较2组术前准备时间、手术时间、X线暴露次数、术中出血量、股骨大粗隆顶点切口长度、骨折愈合时间,末次随访时髋关节功能Harris评分及并发症情况。结果 38例均获得随访,随访时间平均7(5~12)个月。与牵引床组进行比较,手法牵引组术前准备时间、手术时间更短,X线暴露次数更少,术中出血量更小,差异有统计学意义(P<0.05);但2组股骨大粗隆顶点切口长度、骨折愈合时间、髋关节功能Harris评分、并发症比较差异无统计学意义(P>0.05)。结论 PFNA内固定治疗老年股骨粗隆间骨折临床效果满意,采用侧卧位手法牵引闭合复位在术前准备时间、手术时间、X线暴露次数方面体现出明显优势,而且不需要使用牵引床,术者掌握一定技巧后就可操作,值得临床推广应用。

Objective To compare the curative effect of proximal femoral nail anti-rotation （PFNA） in treating femoral intertrochanteric fractures for elderly patients with traction bed or manual traction. Methods Thirty eight elderly patients with femoral intertrochanteric fractures were treated with PFNA internal fixation from December 2011 to December 2016. Nineteen patients underwent manual traction and closed reduction with PFNA internal fixation （manual traction group）, while nineteen patients underwent traction reduction and with PFNA internal fixation （traction bed group）. The preoperative preparation time, operation time, X-ray exposure, intraoperative blood loss, length of incision on the top of femoral trochanter, fracture healing time, complications and Harris scores of hip joint function at the final follow-up were compared between the two groups. Results All 38 patients were followed up for 7 （5-12） months. Compared with the traction bed group, the manual traction group had shorter preoperative preparation time, shorter operation time, fewer X-ray exposures and less intraoperative blood loss, the difference was significant （P 〈0.05）. However, There was no significant difference in the length of incision, healing time of fracture, Harris score of hip joint and complications between the two groups （P 〉0.05）. Conclusion The PFNA internal fixation of femoral intertrochanteric fractures in elderly patients＇ can achieve satisfactory clinical results. With lateral position, manual traction, closed reduction it show significant advantages in preoperative preparation time, operation time, X-ray exposure times. No traction bed is needed. Surgeons can perform after grasping some skills. It is worth of clinical application widely.