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不同手术体位下亚洲型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

Efficacy of different operative positions on Asian proximal femoral anti-rotation intramedullary nail for femoral intertrochanteric fracture in the elderly

摘要:

目的 比较在仰卧位与侧卧位下应用亚洲型股骨近端防旋髓内钉(PFNA-Ⅱ)内固定治疗老年股骨转子间骨折的临床效果. 方法 采用回顾性病例对照研究分析2016年1月-2017年1月收治的128例股骨转子间骨折患者的临床资料,其中男49例,女79例;年龄65~100岁,平均83.2岁.骨折AO分型:A1型27例,A2型82例,A3型19例.根据手术体位不同分为骨科牵引床仰卧位组(66例)和普通手术床侧卧位组(62例).两组均行PFNA-Ⅱ内固定治疗.比较两组体位摆放时间、手术切口长度、手术时间、术中出血量、非负重下床活动时间、骨折愈合时间以及末次随访时髋关节功能Harris评分,观察并发症情况. 结果 患者均获随访12~18个月,平均13.5个月.两组非负重下床活动时间、骨折愈合时间、髋关节功能Harris评分比较差异均无统计学意义(P>0.05).仰卧位组与侧卧位组体位摆放时间分别为(13.6±2.3) min、(6.4±1.6) min;手术切口长度分别为(7.8±1.9)cm、(6.5±1.4)cm;手术时间分别为(51.3±4.1) min、(45.5±5.5)min;术中出血量分别为(99.5 ±3.5)ml、(82.1±3.5)ml(P<0.05或0.01).患者均骨性愈合,元髋内翻、内固定松动或断裂等并发症. 结论 侧卧位行PFNA-Ⅱ内固定治疗老年股骨转子间骨折具有操作简单、创伤更小、手术时间更短、出血更少等优点,值得临床推广.

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abstracts:

Objective To compare the clinical efficacy between supine position and latericumbent position on Asian proximal femoral nail anti-rotation (PFNA-Ⅱ) fixation for femoral intertrochanteric fracture in elderly patients.Methods A retrospective case control study was conducted to analyze the clinical data of 128 patients with intertrochanteric fractures admitted from January 2016 to January 2017.There were 49 males and 79 females,aged 65-100 years,with an average of 83.2 years.According to AO classification of fracture,there were 27 cases of type A1,82 cases of type A2,and 19 cases of type A3.The patients were divided in to supine position group at traction bed (66 cases) and latericumbent position group at regular bed (62 cases) according to the operative position.The two groups were treated with Asian PFNA-Ⅱ internal fixation.The position time,incision length,operation time,intraoperative blood loss,ambulation time without load,fracture healing time,and Harris score of hip function at the last follow up were compared between the two groups.Complications were recorded.Results All patients were followed up for 12-18 months,with an average of 13.5 months.There were no significant differences between the two groups inambulation time without load,fracture healing time,and Harris score of hip joint function (P > 0.05).In the supine position group and the latericumbent position group,respectively,the position time was (13.6 ± 2.3)minutes and (6.4 ± 1.6) minutes,the incision length was (7.8 ± 1.9) cm and (6.5 ± 1.4) cm,the operation time was (51.3 ± 4.1) minutes and (45.5 ± 5.5) minutes,the intraoperative blood loss was (99.5 ± 3.5) ml and (82.1 ±3.5) ml (P < 0.05 or 0.01).All patients were healed without complications such as coxa varus,internal fixation loosening or fracture.Conclusion The Asian PFNA-Ⅱ internal fixation in the latericumbent position for senile intertrochanteric fractures has the advantages of simple procedure,less trauma,shorter operation time,and less bleeding,which is worthy of promotion.

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