程序化模式治疗老年不稳定型股骨粗隆间骨折的围手术期临床疗效

目的探讨程序化模式治疗老年不稳定型股骨粗隆间骨折围手术期的疗效。方法笔者自2015-07—2016-03诊治60例老年不稳定型股骨粗隆间骨折,分为2组,程序化组30例采用正骨手法整复+牵引床维持固定+克氏针体外定位+股骨近端防旋髓内钉(PFNA)内固定的程序化治疗方案;对照组30例采用牵引床复位并PFNA内固定。观察2组复位时间、主钉入髓时间、隐性出血量、首次抬腿时间、并发症等情况。采用髋关节功能Harris评分评定术后疗效。结果所有患者均获得随访12.4(11~18)个月,均获骨性愈合。程序化组骨折复位时间、主钉入髓时间、血液回吸收量、隐性出血量、首次抬腿时间、并发症发生率优于对照组,差异有统计学意义(P0.05)。2组扶拐下地时间、骨折愈合时间比较差异无统计学意义(P0.05)。末次随访疗效根据髋关节功能Harris评分标准评定:程序化组优21例,良6例,可2例,差1例,优良率90.0%,治愈率96.7%;对照组优11例,良10例,可2例,差7例,优良率70.0%,治愈率76.7%,程序化组优良率与治愈率优于对照组,差异有统计学意义(P0.05)。结论对老年不稳定型股骨粗隆间骨折采用程序化模式治疗优于单纯牵引床法,流程中正骨手法整复骨折、牵引床维持复位与微创PFNA内固定疗效满意,值得推广。

Clinical study on perioperative treatment of unstable femoral intertrochanteric fractures with program mode

Objective To investigate perioperative treatment of unstable femoral intertrochanteric fractures of elderly patients with program mode.Methods Sixty elderly patients with unstable intertrochanteric femoral fractures from July 2015 to March 2016 were divided into 2 groups.The programmed group of 30 cases was treated by routine bone setting manipulation,traction bed to maintain fixation,Kirschner in vitro localization and by PFNA internal fixation while the control group of 30 cases was treated by the traction bed reduction and PFNA fixation.The observations included the time of bone setting,the main nail into the marrow,the recessive hemorrhage,start of lifting the leg,and complications.The Harris score was used to evaluate the effect of the operation.Results Sixty patients were followed up for 12 months,all achieved bone healing.The time of the bone setting,the main nail into the marrow and start of lifting the leg,as well as the blood circulation,the recessive hemorrhage and the complications in the programmed group were better than that in the control group,and the difference was statistically significant (P ＜ 0.05).But there were no differences in the time of independent ambulation with crutches and fracture healing between two groups(P ＞0.05).The results of the final follow-up were evaluated according to the criteria of the Harris score on the hip joint function.21 cases of the programmed group were excellent,6 cases were good,2 cases were fair,and 1 case was poor,as a whole the excellent and good rate was 90.0％,the cure rate was 96.7％;11 cases of the control group were excellent,10 cases were good,2 cases were fair,and 7 case were poor,the excellent and good rate was 70.0％ and the cure rate was 76.7％.In brief,the programmed group was better than the control group in the rate of excellent and good results,the difference was statistically significant (P ＜0.05).Conclusion The treatment of unstable femoral intertrochanteric fractures for elderly patients with programming mode of PFNA is better than simple traction bed reduction,which reflects the equal importance of soft tissue and bones in the process,and worths promoting to know.