矢状位牵引在股骨近端防旋髓内钉固定治疗老年股骨转子间骨折中的应用

Sagittal traction in fixation with proximal femoral nail anti-rotation for senile intertrochanteric fractures

目的探讨矢状位牵引在股骨近端防旋髓内钉(PFNA)固定治疗老年股骨转子间骨折中的应用效果。方法回顾性分析2016年1月至2018年1月期间宁波市第九医院骨二科收治的61例老年股骨转子间骨折患者资料。根据是否采用患肢矢状位10°~20°牵引分为两组:水平牵引组31例,男16例,女15例;年龄为(73.6±9.4)岁。矢状位牵引组30例,男15例,女15例;年龄为(75.0±7.2)岁。所有患者均采用PFNA固定治疗。比较两组患者的手术时间、术中出血量、术中透视次数、术后骨折复位质量、骨折愈合时间、6个月髋关节功能及并发症发生情况等。结果两组患者术前一般资料的比较差异均无统计学意义(P>0.05),具有可比性。矢状位牵引组患者的手术时间[(47.1±4.7)min]、术中出血量[(72.3±9.1)mL]、术中透视次数[(11.5±1.4)次]显著少于水平牵引组患者[(56.7±4.6)min、(103.9±19.2)mL、(14.6±1.6)次],差异均有统计学意义(P<0.05)。61例患者术后获6~18个月(平均12.6个月)随访。两组患者术后骨折复位质量、骨折愈合时间及术后6个月髋关节Harris评分的比较差异均无统计学意义(P>0.05)。矢状位牵引组1例患者出现内固定物松动、髋关节疼痛。随访期间两组无一例患者出现切口感染、褥疮、深静脉血栓形成及髋内翻畸形等并发症。结论患肢矢状位10°~20°向上倾斜牵引可避开髂骨翼、臀部软组织及外侧腹壁的阻挡,术者手术操作方便,可有效减少术中出血量及术中透视次数,缩短手术时间。

Objective To observe the effect of sagittal traction on the internal fixation with proximal femoral nail anti-rotation(PFNA)for femoral intertrochanteric fractures in the elderly patients.Methods A retrospective study was conducted to analyze the clinical data of 61 elderly patients with intertrochanteric fracture who had been treated from January 2016 to January 2018 at Department of Orthopaedics,The Ninth Hospital of Ningbo.Of them,horizontal traction of the affected limb was performed in 31(16 males and 15 females with an age of 73.6 years±9.4 years)while 10°-20°sagittal traction of the affected limb in 30(15 males and 15 females with an age of 75.0 years±7.2 years).The 2 groups were compared in terms of operation time,intraoperative blood loss,times of intraoperative fluoroscopy,fracture healing time,hip function at 6 months after operation by Harris scoring and complications.Results There was no statistically significant difference between the 2 groups in the general clinical data,showing comparability(P>0.05).The operation time(47.1 min±4.7 min),intraoperative blood loss(72.3 mL±9.1 mL),and times of intraoperative fluoroscopy(11.5±1.4)in the sagittal traction group were significantly less than those in the horizontal traction group(56.7 min±4.6 min,103.9 mL±19.2 mL,and 14.6±1.6)(P<0.05).This cohort was followed up for 6 to 18 months(12.6 months on average).There were no significant differences between the 2 groups in quality of postoperative fracture reduction,fracture healing time or hip Harris scores at postoperative 6 months(P>0.05).Internal fixation loosening and hip pain occurred in one patient in the sagittal traction group.Follow-ups observed no complications like wound infection,bedsores,deep vein thrombosis or hip varus deformity in either group.Conclusion As 10°-20°sagittal traction can lift the affected limb upward to avid blockage by the iliac wing,hip soft tissue and lateral abdominal wall,it lends convenience to surgeons,reducing intraoperative bleeding volume,times of fluoroscopy and operation time.