两种定位法在股骨转子间骨折手术中应用比较
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摘要
[目的]比较三点定位法和普通定位法在股骨转子间骨折手术中置入股骨颈螺旋刀片的临床效果。[方法]2010年1月~2013年6月共手术治疗股骨转子间骨折患者90例,男48例,女42例,平均年龄(70.50±7.20)岁。骨折按AO分型:A2.1型45例,A2.2型35例,A2.3型10例。按定位方法分为两组,三点组和常规组,每组45例。由同一组医生操作,均采用股骨近端髓内钉(PFNA)固定,但是在置入股骨颈拉力螺钉时方法不同。记录总手术时间、置入螺旋刀片时间、术中出血量、置螺旋刀片曝光次数、尖顶距等指标。[结果]在手术时间[(59.34±9.42)min vs(67.61±12.63)min,P<0.01]、置入螺旋刀片时间[(4.58±1.25)min vs(7.82±2.19)min,P<0.01]、术中出血量[(92.78±34.09)ml vs(154.01±39.10)ml,P<0.01]、曝光次数[(8.84±1.45)vs(14.62±2.91),P<0.01]、尖顶距[(16.78±1.55)mm vs(21.91±3.01)mm,P<0.01]三点组均明显优于常规组,两组间差异有统计学性意义。90例患者中80例获平均12个月随访(10~15个月),三点组42例,常规组38例。三点组无内置物切出发生,常规组2例患者在术后1月发生螺旋刀片切出。术后半年随访两组髋关节Harris评分差异无统计学意义。[结论]三点定位法较普通定位法更快速、准确。
[Objective] To compare the efficacy of three point locating versus routine locating technique for implanting helical blade of proximal femoral nail anti-rotation in treatment of trochanteric fractures. [Method] From January 2010 to June 2013, 90 patients with intertrochanteric fractures were surgically treated, including 48 males and 42 females with an average age of(70.5±7.2) years. According to AO classification, there were 45 cases of A2.1, 35 cases of A2.2 and 10 cases of A2.3. Based on locating technique, the 90 patients were divided into two groups, the three-point group and the routine group,with 45 patients in each group. All operations were performed by the same group of surgeons using proximal femoral nail anti-rotation(PFNA), however, the helical blade inserted into femoral neck with three-point locating technique or usual method in the corresponding group respectively. Total operation time, elapsed time in implanting the helical blade, intraoperative blood loss, X-ray exposure times and tip-apex distance were measured and compared. [Result] The three-point group was significantly superior to the routine group in total operation time [(59.34±9.42) min vs(67.61±12.63) min,P<0.01], elapsed time in implanting the helical blade [(4.58±1.25) min vs(7.82±2.19) min, P<0.01], intraoperative blood loss [(92.78±34.09ml) vs(154.01±39.10) ml, P<0.01], X-ray exposure times [(8.84±1.45) vs(14.62±2.91), P<0.01], and tip-apex distance [(16.78±1.55) mm vs(21.91±3.01) mm, P<0.01]. Of the 90 patients, 80 were followed up for an average time of 12 months(10-15 months), including 42 patients in the three-point group and 38 patients in the routine group. No spiral blade cut out femoral head occurred in any patient of the three-point group, whereas it happened in 2 patients of the routine group a month after surgery. However, there was no a significant difference in Harris score between the two groups at 6 months after operation. [Conclusion] The three-point locating method is faster and more accurate than the routine locating method.
[Objective] To compare the efficacy of three point locating versus routine locating technique for implanting helical blade of proximal femoral nail anti-rotation in treatment of trochanteric fractures. [Method] From January 2010 to June 2013, 90 patients with intertrochanteric fractures were surgically treated, including 48 males and 42 females with an average age of(70.5±7.2) years. According to AO classification, there were 45 cases of A2.1, 35 cases of A2.2 and 10 cases of A2.3. Based on locating technique, the 90 patients were divided into two groups, the three-point group and the routine group,with 45 patients in each group. All operations were performed by the same group of surgeons using proximal femoral nail anti-rotation(PFNA), however, the helical blade inserted into femoral neck with three-point locating technique or usual method in the corresponding group respectively. Total operation time, elapsed time in implanting the helical blade, intraoperative blood loss, X-ray exposure times and tip-apex distance were measured and compared. [Result] The three-point group was significantly superior to the routine group in total operation time [(59.34±9.42) min vs(67.61±12.63) min,P<0.01], elapsed time in implanting the helical blade [(4.58±1.25) min vs(7.82±2.19) min, P<0.01], intraoperative blood loss [(92.78±34.09ml) vs(154.01±39.10) ml, P<0.01], X-ray exposure times [(8.84±1.45) vs(14.62±2.91), P<0.01], and tip-apex distance [(16.78±1.55) mm vs(21.91±3.01) mm, P<0.01]. Of the 90 patients, 80 were followed up for an average time of 12 months(10-15 months), including 42 patients in the three-point group and 38 patients in the routine group. No spiral blade cut out femoral head occurred in any patient of the three-point group, whereas it happened in 2 patients of the routine group a month after surgery. However, there was no a significant difference in Harris score between the two groups at 6 months after operation. [Conclusion] The three-point locating method is faster and more accurate than the routine locating method.
引文
[1]王亦璁.骨与关节损伤[M].3版.北京:人民卫生出版社,2001:865.
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[6]Sahin S,Erturer E,Ozturk I,et al.Radiographic and functional results of osteosynthesis using the proximal femoral nail antirotation(PFNA)in the treatment of unstable intertrochanteric femoral fractures[J].Acta Orthop Traumatol Ture,2010,44(2):127-134.
[7]Lenich A,Mayr E,Ruter A,et al.First results with the trochanter fixation nail(TFN):a report on 120 cases[J].Arch Orthop Trauma Surg,2006,126(10):706-712.
[8]俞超,孙月华,李华,等.计算机导航下空心钉内固定治疗股骨颈骨折[J].中华创伤骨科杂志,2004,6(10):1089.
[9]张耀,赵德伟,芦健民,等.计算机导航下闭合复位空心钉内固定治疗股骨颈骨折[J].中国骨与关节损伤杂志,2009,24(7):587-588.
[10]Schep NW,Van Walsum T,De Graaf J,et al.Validation of fluoroscopy-based navigation in the hip rigion:what you see is what you get[J].Computer Aided Surg,2002,7(5):279.
[11]Grutzner PA,Suhm N.Computer aided long bone fracture treatment[J].Injury,2004,35(1):57-64.
[12]Kane P,Vopat B,Heard W,et al.Is tip apex distance as important as we think?A biomechanical study examining optimal lag screw placement[J].Clin Orthop,2014,472(8):2492-2498.
[13]Pervez H,Martyn JP,Sarah V,Prediction of fixation failure after sliding hip screw[J].Injury,2004,35(8):994-998.
[2]Parker MJ,Bowers TR,Pryo r GA.Sliding hip screw versus the Targon PF nail in the treatment of trochanteric fractures of the hip:a randomised trial of 600 fractures[J].J Bone Joint Surg Br,2012,94(3):391-397.
[3]Grutzner PA,Suhm N.Computer aided long bone fracture treatment[J].Injury,2004,35(1 Suppl):57-64.
[4]Joskowicz L,Milgrom C,Simkin A,et al.FRACAS:a system for computer-aided image-guided long bone fracture surgery[J].Comput Aided Surg,1998,3(6):271-288.
[5]Suhm N.Introoperative accuracy evaluation of virtual fluoroscopya method for application in computer-assisted distal locking[J].Comput Aided Surg,2001,6(4):221-224.
[6]Sahin S,Erturer E,Ozturk I,et al.Radiographic and functional results of osteosynthesis using the proximal femoral nail antirotation(PFNA)in the treatment of unstable intertrochanteric femoral fractures[J].Acta Orthop Traumatol Ture,2010,44(2):127-134.
[7]Lenich A,Mayr E,Ruter A,et al.First results with the trochanter fixation nail(TFN):a report on 120 cases[J].Arch Orthop Trauma Surg,2006,126(10):706-712.
[8]俞超,孙月华,李华,等.计算机导航下空心钉内固定治疗股骨颈骨折[J].中华创伤骨科杂志,2004,6(10):1089.
[9]张耀,赵德伟,芦健民,等.计算机导航下闭合复位空心钉内固定治疗股骨颈骨折[J].中国骨与关节损伤杂志,2009,24(7):587-588.
[10]Schep NW,Van Walsum T,De Graaf J,et al.Validation of fluoroscopy-based navigation in the hip rigion:what you see is what you get[J].Computer Aided Surg,2002,7(5):279.
[11]Grutzner PA,Suhm N.Computer aided long bone fracture treatment[J].Injury,2004,35(1):57-64.
[12]Kane P,Vopat B,Heard W,et al.Is tip apex distance as important as we think?A biomechanical study examining optimal lag screw placement[J].Clin Orthop,2014,472(8):2492-2498.
[13]Pervez H,Martyn JP,Sarah V,Prediction of fixation failure after sliding hip screw[J].Injury,2004,35(8):994-998.