有或无牵引床辅助复位下股骨近端防旋髓内钉治疗老年股骨转子间骨折

Proximal Femoral Nail Anti-rotation(PFNA) with or without Traction Bed Auxiliary Reduction in the Treatment of Intertrochanteric Fractures in Elderly Patients

目的探讨有或无牵引床辅助复位下股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)治疗老年股骨转子间骨折的效果。方法选择2015年1月至2017年4月收治的69例PFNA治疗的老年股骨转子间骨折患者为研究对象,其中A组(仰卧位牵引床辅助复位) 33例和B组(侧卧位无牵引床辅助复位) 36例。选取麻醉时间、手术时间、出血量、透视次数、骨折愈合时间、术后远期并发症及术后Harris髋关节评分为评价指标。结果 B组患者麻醉时间、手术时间、出血量、透视次数明显好于A组患者,差异有统计学意义(P <0. 001)。两组间的骨折愈合时间、术后并发症和术后Harris髋关节评分的差异无统计学意义(P> 0. 05)。结论侧卧位无牵引床辅助复位PFNA技术治疗老年股骨转子间骨折较仰卧位牵引床辅助复位有更好的围手术期优势,二者远期疗效相当。

Objective To discuss and analyze the effects of proximal femoral nail anti-rotation （PFNA） with or without traction bed auxiliary reduction in the treatment of intertrochanteric fractures in the elderly. Methods 69 elderly patients with femoral intertrochanteric fractures admitted from January 2015 to April 2017 treated by PFNA were selected as study objects. They were divided into group A （in supine position with traction bed auxiliary reduction） and group B （in ilateral decubitus position without traction bed auxiliary reduction）. Group A contained 33 cases, and group B contained 36 cases. Anesthesia time, operating time, intraoperative blood loss, X-ray fluoroscopy time, bone union time, postoperative complication rates, and Harris hip joint scores of the two groups were compared. Results Anesthesia time, operating time, intraoperative blood loss and X-ray fluoroscopy time in group B were significantly lower than that of group A （ P 〈0.001）. There was no statistical difference on union time, postoperative complication rates and Harris hip joint scores （one year after surgery） between the two groups （ P 〉0.05）. Conclusion Compared with the traction bed auxiliary reduction in the supine position, it shows a more satisfactory clinical outcome of PFNA applied in elderly patients with intertrochanteric fractures using lateral decubitus position without traction bed auxiliary reduction during perioperative period, and both of them have such a similar prospective efficacy.