不同体位下PFNA治疗老年煤矿工人股骨粗隆间骨折的疗效分析

Efficacy of PFNA with two different positions in the treatment of elderly coal miner patients with femoral intertrochanteric fracture

目的比较非牵引床侧卧位与牵引床下仰卧位应用PFNA内固定治疗老年煤矿工人Evans-JensenⅡ、Ⅲ型股骨粗隆间骨折的临床疗效。方法分析2013年9月至2016年12月期间应用PFNA治疗的70例老年煤矿工人Evans-JensenⅡ、Ⅲ型股骨粗隆间骨折的患者资料,根据手术中体位不同将其分为侧卧位组和仰卧位组,比较两组患者的手术时间、术中出血量、切口长度、术后愈合时间及术后并发症、术后Harris髋关节功能评分等指标。结果 70例患者均获10~27个月随访,平均18.6个月。侧卧位组:手术时间(75.19±5.75)min、术中出血量(150.33±8.07)mL及切口长度(77.22±5.70)mm;仰卧位组:手术时间(89.76±6.52)min、术中出血量(159.97±7.70)mL及切口长度(100.35±6.26)mm,组间比较差异有统计学意义(P<0.05)。侧卧位组:术后并发症发生率为8.3%、骨折愈合时间(12.94±0.92)周、术后6个月的Harris髋关节功能评分为(89.69±6.10)分;仰卧位组:术后并发症发生率8.8%、骨折愈合时间(13.06±1.58)周、术后6个月的Harris髋关节功能评分为(88.76±6.33)分,组间比较差异无统计学意义(P>0.05)。结论两种不同体位下应用PFNA内固定治疗老年煤矿工人Evans-JensenⅡ、Ⅲ型股骨粗隆间骨折均能取得良好的疗效。但是侧卧位非牵引床下使得手术更具微创性,创伤小,出血少,手术操作简便。

Objective To explore the clinical efficacy of proximal femoral nail antirotation (PFNA) between supine position with traction bed and lateral position with non-traction in the treatment of elderly coal miner patients with Evans-Jensen type Ⅱ、Ⅲ femoral intertrochanteric fracture. Methods All 70 cases of elderly coal miner patients with Evans-Jensen type Ⅱ、Ⅲ femoral intertrochanteric fracture after PFNA surgery from September 2013 to December 2016 were divided into two groups: the lateral position group and the supine position group. The clinical efficacy of the two groups was analyzed by comparing the operation time, blood loss, incision length, healing time, complications and Harris scores. Results All 70 patients were followed up for 10 to 27 months, with an average of 18.6 months. Lateral position group: operation time (75.19±5.75) min, intraoperative blood loss (150.33±8.07) mL and incision length (77.22±5.70) mm. Supine position group: operation time (89.76±6.52) min, intraoperative blood loss (159.97±7.70) mL and incision length (100.35±6.26) mm. The difference between groups was statistically significant (P<0.05). Lateral position group: postoperative complication rate 8.3%, fracture healing time (12.94±0.92) weeks, and Harris hip function score (89.69±6.10) at 6 months after operation. Supine position group, postoperative complication rate 8.8%, fracture healing time (13.06±1.58) weeks, and Harris hip function score (88.76±6.33) at 6 months after operation. There was no significant difference between the two groups (P>0.05). Conclusion In two different postures, PFNA surgery can achieve good results in the treatment of elderly coal miner patients with Evans-Jensen type Ⅱ、Ⅲ femoral intertrochanteric fracture. However, the lateral position group with non-traction bed makes the operation more minimally invasive, easier, shorter and less bleeding.