侧卧位牵引复位股骨近端防旋髓内钉治疗难复性股骨转子间骨折

Reduction with proximal femur nail anti-rotation in lateral position for unstable femoral intertrochanteric fracture

背景:难复性股骨转子间骨折往往无法通过牵引床牵引得到良好的复位,需要切开或者应用其他微创复位技术进行辅助复位。目的:探讨侧卧位牵引复位股骨近端防旋髓内钉固定对难复性股骨转子间骨折的复位效果。方法:回顾性分析2013年5月至2015年8月收治的84例难复性股骨转子间骨折患者的资料,均为新鲜骨折,骨折按AO分型:A2型26例,A3型58例。根据骨折复位方法的不同,分为侧卧位手法牵引复位组(A组)和平卧位牵引床牵引复位组(B组),每组42例。分析比较2组患者骨折复位质量、闭合复位失败率、术中失血量、手术时间、透视次数、骨折愈合时间及术后1年Harris评分。结果与结论:(1)A组患者复位效果优于B组,手术时间减少了13 min,术中出血量减少了50.65 m L,透视次数减少了18.59次,术后1年Harris评分增加了10.58分,2组比较差异有显著性意义(P<0.05);(2)提示对于难复性股骨转子间骨折,侧卧位手法牵引复位股骨近端防旋髓内钉固定可以缩短复位操作时间,减少术中血液丢失,提高复位质量,较牵引床复位更有优势。

BACKGROUND： Unstable femoral intertrochanteric fractures often fail to get a good reduction using a traction bed, which usually needs auxiliary reduction by open reduction or other minimally invasive reduction techniques.OBJECTIVE： To explore the treatment outcomes of proximal femur nail anti-rotation（PFNA） on patients with unstable intertrochanteric fracture in lateral position. METHODS： Data of 84 patients with unstable intertrochanteric fractures admitted from May 2013 to August 2015 were analyzed retrospectively. They were acute fractures, and classified by AO classification, including 26 cases of type A2 and 58 cases of A3. The patients were then divided into two groups（n=42 per group）： group A received manual reduction in lateral position, and group B received reduction on a traction bed in horizontal position. The quality of fracture reduction, failure rate of closed reduction, operation time, intraoperative blood loss, fluoroscopy times, healing time and Harris scores at 1 year postoperatively were recorded for comparative analysis. RESULTS AND CONCLUSION：（1） Compared with the group B, in the group A, the quality of reduction was improved, the operation time was reduced by 13 minutes, intraoperative blood loss was reduced by 50.65 m L, fluoroscopy times was reduced by 18.59 times, and the Harris score at 1 year postoperatively was increased by 10.58, and the differences were significant（P 0.05）.（2） In summary, the PFNA in lateral position for reduction of unstable intertrochanteric fractures can shorten the operation time, reduce intraoperative blood loss and improve the reduction efficacy, thus exhibiting a more obvious advantage compared with the traction bed.