PFNa结合钢丝环扎治疗小转子移位的不稳定型股骨转子间骨折疗效分析

Therapeutic Effect of PFNA Combined with Wire Cerclage on Unstable Intertrochanteric Fractures of the Small Trochanter Displaced by Small Trochanter

目的:对本院伴有小转子移位的不稳定型股骨转子间骨折进行PFNa结合钢丝环扎手术的病人资料进行分析观察其治疗效果.方法:采用回顾性分析的研究方法,对本院骨科收治的2015年6月-2017年10月因外伤致伴有小转子移位的不稳定型转子间骨折行PFNa结合钢丝环扎手术治疗的24 例病人进行疗效分析并随访,对手术时间、术中出血量、骨折愈合时间、术后并发症进行分析;并对病人术前、术后及末次随访时的 Harris 评分、VAS 疼痛评分进行分析.结果:所有病人均顺利完成手术治疗.所有随访病人术后均获骨性愈合,愈合时间14-22 周,中位数18周, 未出现感染、内固定物失效、下肢深静脉血栓等并发症.手术时间平均(63. 50 ± 11. 50) 分钟、术中出血量平均(260. 00 ± 60) ml,按 Harris 评分、VAS 疼痛评分进行近期效果评估.术前、术后及随访末次 Harris评分为(30. 60 ± 4. 15)分(23-52分);(65. 30 ± 5. 25)分 (58-79 分);(79. 50 ± 8. 65)分(75-92分),术前、术后及末次随访 VAS 平均分(8. 26 ±0. 70)分(7-10 分);(4. 18 ± 1. 55)分(3-6 分);(1. 65 ± 2. 15)分(0-3分).术前与末次随访时 Harris评分及 VAS 评分均较前明显转优.差异有统计学意义( < 0. 05).结论:PFNa结合钢丝环扎治疗伴有小转子移位不稳定型转子间骨折力学结构合理,钢丝环扎利于维持内侧柱骨块的固定.具有可早期进行功能锻炼,保持骨折对位持久,骨折愈合好,并发症少等优点,对疼痛缓解及髋关节功能均明显改善,有利于病人尽早回归伤前生活方式.

Objective:To analyze the therapeutic effect of PFNA combined with wire cerclage in patients with unstable intertrochanteric fractures in the hospital.M eth ods:A retrospective analysis of 24 cases of PFNA-linked wire cerclage for the treatment of unstable intertrochanteric fractures of the femur with small rotor fractures from June 2015 to 0 ctober2017 in our department of orthopedics was performed.The patients were analyzed for efficacy and follow-up.The operation time,intraoperative blood loss,fracture healing time and postoperative complications were analyzed.The Harris score and VAS pain score were analyzed before,after and at the last foUow-up.R esults:All patients successfully completed the surgical treatment.All patients were followed up for bone healing.The healing time was 14-22 weeks,and the median was 18 weeks.Tliere were no complications such as infection,internal fixation failure,and deep vein thrombosis of the lower extremities.The average operation time was(63.50±11.50)min,and the intraoperative blood loss was(260.00±60)mL.The short-term effect was evaluated according to Harris score and VAS pain score.The Harris scores before,after,and at the end of foUow-up were:(30.60±4.15)points(23-52 points);(65.30±5.25)points(58-79 points);(79.50±8.65)points(75-92 points).preoperative,postoperative,and last follow-up VAS mean score(8.26±0.70)points(7-10 points);(4.18±1.55)points(3-6 points);(1.65±2.15)points(0-3 points).The Harris score and VAS score were significantly higher before and at the last follow-up.The difference was statistically significant.(<0.05).Conclusion:PFNA combined with wire cerclage for the treatment of small rotors with completely displaced medial unstable intertrochanteric fractures has a reasonable mechanical structure,and the wire loop is beneficial to maintain the fixation of the medial column.It has the advantages of early functional exercise,long-lasting fracture alignment,good fracture healing,less complications,and obvious improvement in pain relief and hip function,which is conducive to patients returning to the pre-injury lifestyle as soon as pjossible.