2种穿钉方法在经皮组合式外固定架治疗老年股骨粗隆间骨折中的应用

目的比较2种穿钉方法在经皮组合式外固定架治疗老年股骨粗隆间骨折中的临床疗效。方法笔者回顾性分析自2007-01—2015-01分别采用股骨颈首钉定位法与传统股骨颈穿钉法并组合式外固定架固定治疗老年股骨粗隆间骨折52例,比较2组手术时间、术中出血量、术中透视次数、术中穿钉失败次数、术后皮肤切割疼痛及浅表感染例次、术后内固定失效例次、髋关节内翻畸形例次、髋关节功能优良率。结果观察组获得随访平均31.2(12~96)个月,对照组获得随访平均27.8(12~96)个月。观察组在手术时间、术中透视次数、术中穿钉失败次数、术后皮肤切割疼痛及浅表感染方面优于对照组,差异有统计学意义(P0.05);2组术中出血量、术后内固定失效率及髋关节内翻比较差异无统计学意义(P0.05)。2组均无血管神经损伤及内固定断裂,骨折均获骨性愈合。结论与传统组合式外固定架术相比,股骨头颈首钉定位法并组合式外固定架治疗老年股骨粗隆间骨折,手术操作简单、安全、高效,可以明显减少术中反复透视、减少医护人员放射线损害,缩短手术时间,减少外固定钢钉切割皮肤引起的不适感。

Two methods of application of femoral neck screw in percutaneous combined external fixator for treatment of intertrochanteric fractures in elderly patients

Objective To compare the clinical effect of two methods of application of the femoral neck screw in percutaneous combined external fixator for treatment of femoral intertrochanteric fractures in elderly patients.Methods A retrospective analysis was employed to analyze the clinical data from 52 elderly patients with femoral intertrochanteric fractures from January 2007 to January 2015.The operation time,amount of intraoperative blood loss,intraoperative X ray show times,intraoperative puncture failure rate,postoperative skin incision pain and superficial infection rate,postoperative internal fixation failure rate,hip varus deformity rate,and hip joint function excellent rate were recorded.Results The observation group was followed up for an average of 31.2 months(12-96) while the control group received an average of 27.8 months(12-96).In the observation group,the operation time,intraoperative X ray show times,intraoperative puncture failure rate,postoperative skin incision pain and superficial infection rate were better than the control group (P ＜0.05);There was no significant difference in blood loss,postoperative internal fixation failure rate and hip varus rate (P ＞0.05).No neurovascular injuries and internal fixation failure were found in 2 groups.Both groups were bony union finally.Conclusion Compared with the traditional femoral neck screw in percutaneous combined external fixator,the first nail positioning of femoral neck method in treatment of senile femoral intertrochanteric fracture with combined external fixation,is simple,safe and effective,which can significantly reduce the times of use of the X-ray machine of C-arm in the operation,reduce the medical personnel radiation damage,shorten the operation time,and reduce the discomfort caused by skin incision through the pin.