C臂机引导下徒手置入导针在股骨近端防旋髓内钉固定术中的应用

Application of unarmed guided needle placement guided by C-arm machine in proximal femoral nail anti-rotation fixation surgery

目的探讨C臂机引导下徒手置入导针在股骨近端防旋髓内钉(PFNA)固定术中的应用效果。方法按照置入导针方式不同将74例股骨转子间骨折患者分为常规组(常规方式置入导针行PFNA固定治疗,38例)和徒手组(C臂机引导下徒手置入导针行PFNA固定治疗,36例)。记录两组术中透视次数及时间、手术时间、开始负重时间、骨折愈合时间。采用Harris评分评价髋关节功能。结果患者均获得随访,时间6~24个月。术中透视次数及时间、开始负重时间徒手组均少(短)于常规组(P<0.05)。手术时间、骨折愈合时间两组比较差异均无统计学意义(P>0.05)。术后6个月Harris评分徒手组高于常规组(P<0.05)。结论C臂机引导下徒手置入导针行PFNA固定治疗股骨转子间骨折,便于调整进针点,有效减少术中透视次数和缩短透视时间,更利于患者早期负重,且能有效恢复髋关节功能。

Objective To explore the application effect of unarmed guided needle placement guided by C-arm machine in proximal femoral nail anti-rotation(PFNA)fixation surgery.Methods The 74 patients with femoral intertrochanteric fractures were divided into the conventional group(38 cases were treated with PFNA fixation using conventional placement method of guided needle)and unarmed group(36 cases were treated with PFNA fixation using unarmed guided needle placement guided by C-arm machine),according to the different placement methods.The frequency and time of intraoperative fluoroscopy,surgical time,and starting time of weight-bearing and fracture healing in both groups were recorded.Harris score was used to evaluate hip joint function.Results All patients were followed up for 6~24 months.The frequency and time of intraoperative fluoroscopy,starting time of weight-bearing in the unarmed group were less(shorter)than those of the conventional group(P<0.05).There were no statistical differences in surgical time and fracture healing time between the two groups(P>0.05).At 6 months after surgery,the Harris scores were higher in the unarmed group than the conventional group(P<0.05).Conclusions Under the guidance of C-arm machine,PFNA fixation with unarmed placement of guide needles for the treatment of the femoral intertrochanteric fractures is convenient for adjusting the insertion point,effectively reducing the frequency and time of intraoperative fluoroscopy,which is more conducive to early weight-bearing for patients,and can effectively restore hip joint function.