不同体位下股骨近端防旋髓内钉内固定治疗股骨转子间骨折肥胖患者效果观察

目的观察肥胖患者发生股骨转子间骨折时取平卧位与侧卧位下股骨近端防旋髓内钉（PFNA）内固定治疗的效果。方法 2010年1月—2013年6月河北医科大学附属邢台市人民医院采用PFNA治疗股骨转子间骨折肥胖患者（体质量指数〉26 kg/m^2）43例,根据体位不同分为平卧位组（21例）与侧卧位组（22例）。比较两组术中出血量、手术时间、转子顶端切口长度、住院时间、开始负重时间、骨折愈合时间、髋关节Harris评分及术后并发症发生率。结果侧卧位组手术时间、转子顶端切口长度较平卧位组短,术中出血量较平卧位组少,差异有统计学意义（P〈0.05）。两组住院时间、开始负重时间、骨折愈合时间、髋关节Harris评分比较差异无统计学意义（P〉0.05）。侧卧位组并发症发生率（13.6%）明显低于仰卧位组（38.1%）,差异有统计学意义（P〈0.05）。结论对于股骨转子间骨折肥胖患者,侧卧位下行PFNA内固定术能充分暴露术区、有效降低手术难度、减少术中出血量、缩短手术切口长度和手术时间,较平卧位有明显优势。

Effect of Internal Fixation Using Proximal Femoral Nail Anti-rotation in Treatment of Obese Patients with Intertrochanteric Femoral Fracture in Different Postures

Objective To observe the effect of internal fixation using proximal femoral nail anti-rotation（ PFNA） in treatment of obese patients with intertrochanteric femoral fractures in horizontal and lateral postures. Methods A total of 43 obese patients（ body mass index 〉26 kg / m^2） with intertrochanteric femoral fracture received internal fixation using PFNA in the People＇s Hospital of Xingtai City,affiliated to Hebei Medical University during January 2010 and June 2013. The patients were divided into horizontal position group（ n = 21） and lateral position group（ n = 22） according to different postures. The values of intraoperativon blood loss,operative stay,incision length of the top rotor,hospitalization stay,beginning weight-bearing time,fracture healing time,Harris score of hip joint and incidence rate of postoperative complications in the two groups were compared. Results The values of operation stay and incision length of the top rotor in lateral posture group were shorter than those in horizontal posture group,and the intraoperative blood loss of lateral posture group was less than that in horizontal posture group,and the differences were statistically significant（ P 〈0. 05）. The differences in hospitalization time,beginning weight-bearing time,fracture healing time and Harris score of hip joint between the two groups were not statistically significant（ P 〉0. 05）. The incidence rate of postoperative complications in lateral posture group（ 13. 6%） was significantly lower than 38. 1% in horizontal posture group（ P 0. 05）.Conclusion Internal fixation using PFNA in lateral posture in treatment of obese patients with intertrochanteric femoral fractures may fully expose the operative area,effectively reduce the operative difficulty,reduce intraoperative blood loss volume,shorten incision length and operation time. Obviously it has advantages over those by internal fixation using PFNA in horizontal position.