不同体位下股骨近端防旋髓内钉治疗老年股骨转子间骨折的疗效比较

Comparison effect of proximal femoral nail anti-rotation with different positions in the treatment of elderly femoral intertrochanteric fracture

目的比较牵引床平卧位和无牵引床侧卧位两种体位下行股骨近端防旋髓内钉(PFNA)治疗老年股骨转子间骨折的临床疗效。方法根据手术体位的不同将48例老年股骨转子间骨折患者分为牵引床平卧位组(采用牵引床平卧位下行PFNA治疗,24例)和无牵引床侧卧位组(采用无牵引床侧卧位下行PFNA治疗,24例)。比较两组手术情况及术后并发症发生情况,采用Harris评分系统评估髋关节功能恢复情况。结果48例均获得随访,时间6~18个月。手术时间、术中透视时间、术中出血量无牵引床侧卧位组均短(少)于牵引床平卧位组(P<0.01);术后颈干角无牵引床侧卧位组大于牵引床平卧位组(P<0.01)。尖顶距、术后开始负重时间、骨折愈合时间、术后6个月Harris评分及术后并发症发生率两组比较差异均无统计学意义(P>0.05)。结论牵引床平卧位和无牵引床侧卧位两种体位下行PFNA治疗老年股骨转子间骨折均能获得良好的临床疗效,无牵引床侧卧位下手术视野暴露更清晰,术中出血量更少,手术时间更短。

Objective To compare the clinical efficacy of proximal femoral nail anti-rotation(PFNA)in the treatment of elderly femoral intertrochanteric fracture in supine position with traction bed and lateral decubitus without traction bed.Methods According to different surgical positions,48 elderly patients with femoral intertrochanteric fractures were divided into traction bed supine position group(24 cases were treated with PFNA in traction bed supine position)and lateral decubitus without traction bed group(24 cases were treated with PFNA in lateral decubitus without traction bed).The operation situation and postoperative complications of the two groups were compared,and the functional recovery of hip joint was evaluated by Harris scoring system.Results All 48 patients were followed up for 6~18 months.The operative time,intraoperative fluoroscopy time and intraoperative blood loss were shorter(less)in the lateral decubitus without traction bed group than those in the traction bed supine group(P<0.01).Postoperative femoral inclination angle of the lateral decubitus without traction bed group was larger than the traction bed supine group(P<0.01).There were no significant differences in tip-apex distance,postoperative starting weight-bearing time,fracture healing time,Harris score of postoperative 6 months and incidence rate of postoperative complications between the two groups(P>0.05).Conclusions In the treatment of elderly intertrochanteric fractures,PFNA in traction bed supine position and lateral decubitus without traction bed both can achieve good clinical efficacy.PFNA in lateral decubitus without traction bed has clearer surgical field exposure,less intraoperative blood loss and shorter operation time.