沪滇对口帮扶医院骨折治疗模式的转变

目的以沪滇医疗对口帮扶前后云南省昌宁县人民医院治疗股骨粗隆间骨折模式的转变，分析帮扶项目提高对口医院医疗服务能力的方案。 方法回顾性分析云南省昌宁县人民医院2012年10月至2017年10月在帮扶下技术改进前后2种手术方式治疗股骨粗隆间骨折的效果，按帮扶前后2种手术方式分为帮扶前股骨近端锁定钢板固定组（钢板组）17例和帮扶后股骨近端防旋髓内钉（PFNA）内固定组（PFNA组）25例，使用t检验比较2组患者手术时间、术中出血量、开始负重时间、完全负重时间、术后1年髋关节Harris评分及住院费用等情况的差异，采用χ²检验比较2组患者术后并发症的差异。 结果42例患者术后随访12~18个月，平均14.3个月。PFNA组平均手术时间、术中出血量、开始负重时间、完全负重时间及住院费用低于钢板组［（86.80±28.97）min vs （156.76±31.70）min、（116.40±52.59）ml vs（273.53±113.85）ml、（12.50±3.72）d vs（20.19±5.98）d、（13.71±2.26）周vs（17.75±2.02）周、（14.40±1.94）千元vs（17.53±1.59）千元］，Harris评分总分高于钢板组［（91.05±4.89）分vs（80.14±8.82）分］，差异均具有统计学意义（P<0.05）。术后并发症发生率PFNA组（4/25）低于钢板组（7/17），且差异具有统计学意义（χ²=42.000，P<0.01）。 结论医疗帮扶能改善对口医院骨折的治疗模式，提高股骨粗隆间骨折治疗效果，减少因病致残、因病致贫的发生。

Transition of treatments for fractures in Shanghai-Yunnan counterpart assisting hospitals

ObjectiveTo analyze the changes in the treatments for femoral intertrochanteric fractures in Changning People's Hospital of Yunnan Province before and after Shanghai-Yunnan medical counterpart assistance to improve the medical service capacity of assisting hospitals. MethodsA retrospective analysis was performed on the effects of two surgical methods for the treatment of intertrochanteric fractures that were implemented before and after technical improvement, respectively, from October 2012 to October 2017 at Changning People′s Hospital of Yunnan Province. According to the surgical method used, the patients were divided into either an anterior locking plate fixation group (plate group, n=17) or a proximal femoral nail antirotation (PFNA) group (n=25). The t-test and χ² test were used to compare the operation time, intraoperative blood loss, time to initial weight-bearing, time to total weight-bearing, postoperative complications, hip Harris score at 1 year postoperatively, and hospital costs of the two groups. The operation time of the same doctor for PFNA was analyzed. ResultsThe 42 patients were followed for 12 to 18 months with an average of 14.3 months. The average operation time, intraoperative blood loss, time to initial weight-bearing, time to total weight-bearing, hospitalization cost, and Harris score in the PFNA group were significantly less than those in the plate group (86.80±28.97) min vs (156.76±31.70) min, (116.40±52.59) ml vs (273.53±113.85) ml, (12.50±3.72) d vs (20.19±5.98) d, (13.71±2.26) weeks vs (17.75±2.02) weeks, (14.40±1.94)×10³ yuan vs (17.53±1.59)×10³ yuan, (80.14±8.82) scores vs (91.05±4.89) scores; P<0.05]. The incidence of postoperative complications was lower in the PFNA group (4/25) than in the plate group (7/17), the difference was statistically significant (χ²=42.000, P<0.01). ConclusionMedical assistance can improve the therapeutic effects on intertrochanteric fractures and reduce the incidence of disability and poverty due to illness.