股骨近端防旋髓内钉治疗高龄股骨粗隆间骨折的手术时机

Operation timing of proximal femoral nail anti-rotation for femoral intertrochanteric fracture in the advanced age

[目的]探讨高龄股骨粗隆间骨折的手术时机,以减少并发症。[方法]回顾性分析2017年1月~2018年8月南通大学附属南京江北人民医院骨科中心符合标准的136例高龄(≥75岁)股骨粗隆间骨折患者的临床资料,按照手术时机分为≤48 h组及>48 h组,对比分析两组患者疗效。[结果]两组患者均顺利手术,其中>48 h组有6例闭合复位不佳,而≤48 h组有2例闭合复位不佳。两组在手术时间、术中出血量、术中输血量、术后输血量方面比较差异无统计学意义(P>0.05),但≤48 h组住院时间及住院费用明显低于>48 h组,差异有统计学意义(P<0.05)。在并发症方面,≤48h组在肺部感染、静脉血栓、泌尿道感染、心功能障碍、压疮的发生方面明显低于>48 h组,差异有统计学意义(P<0.05);而在肺栓塞的发生、围术期死亡率、急性脑梗死方面差异无统计学意义(P>0.05)。两组患者均获得6~18个月随访,平均(12.42±1.54)个月,随时间延长,两组患者临床症状、体征和功能均逐步改善。两组患者在骨折愈合时间、发生再次骨折及内固定松动方面差异无统计学意义(P>0.05)。但末次随访时≤48 h组的髋关节功能Harris评分及优良率显著高于>48 h组,差异有统计学意义(P<0.05)。[结论]对高龄股骨粗隆间骨折患者48 h内积极行手术治疗,可明显降低术后并发症的发生率。

[Objective] To explore the optimal operation timing of proximal femoral nail anti-rotation(PFNA) for femoral intertrochanteric fracture in the advanced age to reduce complications. [Methods] A retrospective study was conducted on 136 patients who were old equal to or more than 75 years, and underwent close reduction and internal fixation with PFNA for femoral intertrochanteric fracture from January 2017 to August 2018 in our department. Based on time elapsed between injury and operation, the patients were divided into the ≤48 h group and the >48 h group. The clinical outcomes were compared between the two groups. [Results] All the patients in both groups had operation performed smoothly with improper close fracture reduction in6 patients of the >48 h group, while only 2 of the ≤48 h group. Although no statistically significant differences were noted regarding operation time, intraoperative blood loss, intraoperative transfusion and postoperative transfusion between the two groups(P>0.05), the ≤ 48 h group spent significantly shorter hospital stay and significantly less hospital expenses than the >48 h group(P<0.05). Regarding to complications,the ≤48 h group had significantly lower incidence of pulmonary infection, venous thrombosis, urinary tract infection,cardiac dysfunction and pressure sore than the >48 h group(P<0.05), whereas no significant differences were found in incidence of pulmonary embolism, perioperative death, and acute cerebral infarction between them(P>0.05). The patients in both groups were followed up for 6~18 months with an average of(12.42±1.54) months. As time went postoperatively, the patients in both groups achieved considerable improvements in symptoms, sign and function. Despite of the facts that no significant differences were noticed in fracture healing time, incidence of refracture and implant loosening between the two groups, the ≤48 h group had significantly higher Harris score than the >48 h group at the latest follow-up(P<0.05). [Conclusion] As soon as thorough preoperative evaluation and active preoperative preparation finished, the internal fixation with PFNA should be performed for femoral intertrochanteric fracture in advanced age within 48 hours to reduce complication.