闭合复位股骨近端抗旋髓内钉治疗不稳定性股骨转子间骨折 61例

目的 探讨闭合复位股骨近端抗旋髓内钉(PFNA)治疗不稳定性股骨转子间骨折的效果.方法 回顾性分析2014年10月至2018年10月在冀中能源峰峰集团总医院行手术治疗的不稳定性股骨转子间骨折(AO/OTA 31-A2,A3型)病人120例,依据手术方式的不同分为对照组与观察组,对照组59例行动力髋螺钉(DHS)治疗,观察组61例行PFNA治疗.对比两组手术指标、Harris评分与生活自理能力,测定血红蛋白与血细胞比容水平,统计并发症发生率.结果 观察组切口长度短于对照组(6.68±2.19)cm比(11.43±2.65)cm,P<0.05],总失血量(565.93±173.68)mL比(946.37±325.31)mL]、术后引流量(72.48±10.61)mL比(82.65±11.42)mL]均少于对照组(P<0.05),手术时间(63.56±8.77)min比(82.08±9.13)min]、住院时间(15.68±4.14)d比(22.76±5.43)d]、部分负重时间(10.18±2.06)d比(16.91±5.29)d]均少于对照组(P<0.05),两组骨折愈合时间比较,差异无统计学意义(10.89±2.64)d比(11.35±2.46)d,P>0.05];随访1年两组Harris评分与生活自理能力评分均高于术前(P<0.05),且随访1年观察组Harris评分(83.63±11.32)分比(80.05±7.64)分]与生活自理能力评分(90.09±3.13)分比(79.85±4.26)分]高于对照组(P<0.05);术后7 d两组血红蛋白与血细胞比容水平均低于术前(P<0.05),且术后7 d观察组血红蛋白与血细胞比容水平均高于对照组(P<0.05);观察组并发症总发生率低于对照组(6.56％比23.73％,P<0.05).结论 闭合复位PFNA治疗不稳定性股骨转子间骨折,能优化多项手术指标,提高髋关节功能与生活自理能力,减少失血量,且有助于预防并发症发生.

Effect of closed reduction and PFNA in the treatment of unstable intertrochanteric fracture

Objective Toinvestigate the effect ofclosedreductionandproximalfemoralnailantirotation (PFNA)inthetreatment ofunstableintertrochanteric fracture.Methods Onehundred and twenty patients withunstable intertrochanteric fracture (AO/OTA 31-A2,A3type) who were operated in Jizhong Energy Fengfeng Group General Hospital from October 2014 to October 2018 were analyzed retrospectively. According to the different operation methods, they were assigned into control group and study group, 59 patients in control groupwere treated with dynamic hip screw (DHS) and 61 patients in study group were treated with PFNA. The operation index, Harris score andself-care ability were compared between the two groups, the levels of hemoglobin and hematocrit were measured, and the incidence of complications was counted.Results The incision length of the study group was shorter than that of the control group (6.68±2.19) cm vs. (11.43±2.65) cm, P<0.05]; the total blood loss (565.93±173.68) mL vs. (946.37±325.31) mL] and postoperative drainage (72.48±10.61) mL vs. (82.65±11.42) mL] were less than those in the control group (P<0.05); the operation time (63.56±8.77) min vs. (82.08±9.13) min], hospitalization time (15.68±4.14) d vs. (22.76±5.43) d] and partial load-bearing time (10.18±2.06) d vs. (16.91±5.29) d] were all less than those in the control group (P<0.05), while there was no significant difference in fracture healing time between the two groups (10.89±2.64) d vs.(11.35±2.46)d, P>0.05]; after 1yearfollow-up,Harris score (83.63±11.32) vs.(80.05±7.64)]and self-careabilityscore (90.09±3.13) vs. (79.85±4.26)] of the two groups were higher than those before operation (P<0.05), and the Harris score and self-care ability score of the study group were higher than those of the control group (P<0.05); the levels of hemoglobin and hematocrit in the two groups were lower than those before operation (P<0.05), and the levels of hemoglobin and hematocrit in the study group were higher than those in the control group (P<0.05); and the total incidence of complications in the study group was lower than that in the control group (6.56% vs. 23.73%, P<0.05). Conclusion Closed reduction and PFNA in the treatment of unstable intertrochanteric fracture can optimize a number of surgical indicators,improvethefunctionofhipjointandself-careabilityoflife,reducebloodloss,andhelptopreventcomplications.