辅助线优化股骨近端髓内钉手术治疗简单股骨粗隆间骨折

目的:探讨术前通过C形臂X线透视体表定位辅助线,术中利用辅助线引导,置入股骨近端抗旋髓内钉的主钉和螺旋刀片导针的临床效果。方法:回顾分析2012年1月1日至2015年1月1日行闭合复位股骨近端抗旋髓内钉内固定AO31A1型和31A2型股骨粗隆间骨折患者共132例,传统手术组62例,其中男14例,女48例,年龄52~95岁,平均(69.58±8.55)岁,采用传统手术方式;辅助线组70例,其中男15例,女55例,年龄61~88岁,平均(71.94±7.64)岁,在传统手术方式基础上,增加了体表和C形臂X线透视的辅助线定位,并在术中使用这些辅助线指导股骨近端抗旋髓内钉主钉和螺旋刀片的导针定位。比较两组间手术时间、总透视次数、术后3个月随访时Harris评分、并发症发生情况。结果:除辅助线组1例患者出现创口浅表感染的并发症外,其余患者创口均Ⅰ期愈合。132例患者术后随访,时间3~18个月,平均(6.81±3.07)个月。辅助线组手术时间(56.16±6.36)min较传统手术组(59.06±9.19)min明显缩短(P=0.035),辅助线组总透视次数25.89±5.81明显少于传统手术组31.32±9.81(P0.001)。两组术后并发症发生率、术后3个月Harris评分差异均无统计学意义(P0.05)。结论:辅助线标记法简单易行,能够明显缩短手术时间,减少术中透视次数。

Otimization of auxiliary lines for proximal femoral intramedullary nail in the treatment of simple femoral intertrochanteric fractures

Objective: To investigate the clinical outcomes of C-arm X-ray fluoroscopy before incision to make assistant lines and insert the guide wire of PFNA and PFNA blade.Methods: From January 1st 2012 to January 1st 2015,132 intertrochanteric fracture patients of type 31A1 and 31A2 according to AO-classification,were retrospectively analyzed. Among them,62 patients(14 males and 48 females) aged from 52 to 95 years with a mean age of(69.58±8.55) years in traditional group were operated by traditional procedure,while 70 patients in the skin marking group included 15 males and 55 females aged from 61 to 88 years with a mean age of(71.94±7.64) years,on the basis of the traditional operation method,the assistant line of the body surface and the C-arm X-ray was increased,and the guide pin positioning of the proximal femoral nail and the spiral blade was guided by the auxiliary line in the operation. Operative time,frequency of C-arm fluoroscopy,Harris hip score of the third months after surgery and the complications in both groups were queried for statistical analysis.Results: In addition to skin making group 1 patients had superficial wound infection complications,all patients were stage I wound healing. All patients were followed up for 3 to 18 months with an average of (6.81±3.07) months. The operative time was significantly reduced in skin marking group (56.16±6.36) minutes compared to traditional group (59.06±9.19) minutes (P=0.035). And the frequency of C-arm fluoroscopy of skin marking group was(25.89±5.81) times which was also significantly reduced compared to traditional group(31.32±9.81) times (P<0.001). There was no statistical difference in Harris hip score at 3 months after operation and the complication rate between the two groups(P>0.05).Conclusion: In this study,a simple and easy method of assistant line marking can shorten the operation time and reduce the number of times of operation.