牵引床仰卧位与非牵引床侧卧位PFNA手术治疗股骨粗隆间骨折疗效比较

目的比较牵引床仰卧位与非牵引床侧卧位行股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)手术治疗股骨粗隆间骨折的临床疗效。方法回顾分析2013年1月-2018年4月收治的符合选择标准的102例股骨粗隆间骨折老年患者,根据手术体位不同,将患者分为A组(50例,牵引床仰卧位行PFNA内固定治疗)和B组(52例,非牵引床侧卧位行PFNA内固定治疗)。两组患者年龄、性别、骨折侧别、致伤原因、骨折AO分型、合并症、受伤至手术时间等一般资料比较差异,均无统计学意义(P>0.05),具有可比性。记录并比较两组患者术前准备时间、切口长度、手术时间、术中出血量、术中X线透视次数、骨折愈合时间及并发症发生情况;术后1年采用Harris髋关节评分标准评价手术疗效。结果A、B组间除切口长度比较差异无统计学意义(t=1.116,P=0.268)外,A组术前准备时间、手术时间、术中出血量、术中X线透视次数均显著大于B组(P<0.05)。两组患者均获随访,随访时间12~14个月,平均13个月。A、B组分别有3例出现术后并发症,其中A组有2例出现髋关节疼痛症状、1例出现伤口局限性脂肪液化(经换药后愈合),B组有2例出现髋关节疼痛症状、1例出现下肢深静脉血栓形成;两组术后并发症发生率比较差异无统计学意义(P=0.642)。两组患者骨折复位、内固定质量均良好,无主钉松动、断裂,螺旋刀片切割、退出及断钉等现象,无骨不连及髋内翻等并发症发生。X线片示两组骨折均愈合,愈合时间比较差异无统计学意义(t=1.515,P=0.133)。术后1年两组患者髋关节Harris评分比较差异无统计学意义(t=0.778,P=0.438)。结论与牵引床仰卧位比较,非牵引床侧卧位行PFNA内固定手术治疗股骨粗隆间骨折,具有术前准备时间短、手术时间短、术中出血量少、X线透视次数少、术后恢复效果满意的优点。

Comparison of proximal femoral nail anti-rotation operation in traction bed supine position and non-traction bed lateral position in treatment of intertrochanteric fracture of femur

Objective To compare the effectiveness of proximal femoral nail anti-rotation(PFNA) in the treatment of intertrochanteric fracture of femur in traction bed supine position and non-traction bed lateral position.Methods A retrospective analysis of 102 elderly patients with intertrochanteric fracture of femur who met the selection criteria between January 2013 and April 2018 was made. According to the different operative positions, the patients were divided into two groups: group A(50 cases, PFNA internal fixation in traction bed supine position) and group B(52 cases,PFNA internal fixation in non-traction bed lateral position). There was no significant difference in age, gender, fracture side, cause of injury, AO classification, complications, and time from injury to operation between the two groups(P>0.05).The preoperative preparation time, incision length, operation time, intraoperative blood loss, intraoperative X-ray fluoroscopy times, fracture healing time, and complications were recorded and compared between the two groups,and the effectiveness was evaluated by Harris hip score at 1 year after operation. Results There was no significant difference in incision length between groups A and B(t=1.116, P=0.268). In addition, the preoperative preparation time,operation time, intraoperative blood loss, and intraoperative X-ray fluoroscopy times in group A were significantly greater than those in group B(P<0.05). Both groups were followed up 12-14 months, with an average of 13 months. There were3 postoperative complications in group A and group B respectively. In group A, there were 2 cases of hip joint pain and1 case of local fat liquefaction(healed after dressing change);in group B, there were 2 cases of hip joint pain and 1 case of deep vein thrombosis in lower extremity;there was no significant difference in the incidence of postoperative complications between the two groups(P=0.642). The patients of the two groups had a good result of fracture reduction and the internal fixation quality, and there was no main nail loosening, screw fracture, spiral blade cutting, withdrawal,and the nail breakage occurred, and no nonunion of bone, coxa vara, and other complications occurred. X-ray showed that the fracture healed in both groups, and there was no significant difference in fracture healing time between the two groups(t=1.515, P=0.133). There was no significant difference in Harris hip score between the two groups at 1 year after operation(t=0.778, P=0.438). Conclusion Compared with the traction bed supine position, PFNA internal fixation for intertrochanteric fracture of femur in the non-traction bed lateral position has the advantages of short preparation time,short operation time, less intraoperative blood loss, less X-ray fluoroscopy times, and satisfactory postoperative recovery effect.