股骨粗隆间骨折PFNA术中改良克氏针固定的应用分析

Application of modified Kirschner wire fixation in PFNA for intertrochanteric femoral fractures

目的回顾性分析改良克氏针固定在侧卧位下行股骨近端防旋髓内钉(PFNA)治疗Evans-JensenⅣ型股骨粗隆间骨折的临床疗效。方法选取该院2018年12月至2019年12月收治的68例Evans-JensenⅣ型股骨粗隆间骨折患者,均采用PFNA治疗。根据采用的不同手术方法进行分组,常规组34例不使用克氏针固定,试验组34例使用改良克氏针固定。比较分析两组患者手术时间、术中出血量、术中透视次数、术后并发症、骨折愈合时间、术后12个月髋关节功能评分。结果两组术后并发症发生率、骨折愈合时间及髋关节功能Harris评分比较,差异均无统计学意义(P>0.05)。与常规组比较,试验组手术时间[(73.26±7.78)min vs.(77.88±6.35)min]缩短,术中出血量[(52.63±8.68)mL vs.(72.61±12.63)mL]、术中透视次数[(9.74±1.58)次vs.(11.94±2.59)次]减少,差异均有统计学意义(P<0.05)。结论股骨粗隆间骨折PFNA术中,采用手法复位后克氏针固定骨折断端的方法可有效缩短手术时间,减少术中出血,减少术中透视。

Objective To retrospectively analyze the clinical efficacy of modified Kirschner wire fixation in the lateral position with proximal femoral anti-rotation intramedullary nailing(PFNA)in the treatment of Evans-Jensen typeⅣfemoral intertrochanteric fractures.Methods A total of 68 patients with Evans-Jensen typeⅣfemoral intertrochanteric fractures admitted to this hospital from December 2018 to December 2019 were selected and treated with PFNA.The patients were grouped according to the different surgical methods used,34 cases in the conventional group were fixed without the use of Kirschner wire,and 34 cases in the experimental group were fixed with modified Kirschner wire.The operative time,intraoperative blood loss,number of intraoperative fluoroscopies,postoperative complications,fracture healing time and evaluation of the hip function at 12 months after surgery were compared and analyzed between the two groups.Results There was no statistically significant difference in the incidence of postoperative complications,fracture healing time and Harris score of hip function between the two groups(P>0.05).Compared with the conventional group,the experimental group had shorter operative time[(73.26±7.78)min vs.(77.88±6.35)min],less intraoperative blood loss[(52.53±8.68)mL vs.(72.61±12.63)mL]and fewer intraoperative fluoroscopies[(9.74±1.58)times vs.(11.94±2.59)times],and there were statistically significant differences(P<0.05).Conclusion In PFNA of femoral intertrochanteric fracture,the method of fixing the broken end of the fracture with Kirschner wire after manual repositioning can effectively shorten the operative time,reduce the intraoperative bleeding and intraoperative fluoroscopy.