不同体位PFNA治疗老年股骨粗隆间骨折疗效比较
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摘要
目的比较侧卧位与仰卧位股骨近端防旋髓内钉(PFNA)内固定治疗老年股骨粗隆间骨折的临床疗效。方法选择2014年10月至2015年10月间中山市中医院骨科收治的160例股骨粗隆间骨折患者为研究对象,根据随机数表法分为对照组和观察组,每组80例。所有患者均行PFNA内固定术治疗,其中对照组常规仰卧位,观察组侧卧位,比较两组患者的临床疗效,术后随访1年,根据Harris评分评价髋关节功能恢复情况。结果观察组患者的切口长度、手术时间分别为(4.72±1.78)cm、(41.72±12.36)min,明显短于对照组的(6.28±2.95)cm、(55.29±27.42)min,术中出血量为(74.58±38.37)m L,明显少于对照组的(104.53±45.29)m L,差异均有统计学意义(P<0.05);两组患者的术后骨折愈合时间比较,差异无统计学意义(P>0.05);观察组与对照组患者的并发症发生率分别为8.75%和11.25%,术后1年Harris髋关节功能评分优良率分别为95.00%和91.25%,两组比较差异均无统计学意义(P>0.05)。结论 PFNA是治疗老年股骨粗隆间骨折的有效术式,仰卧位及侧卧位均可取得较好的疗效,但是侧卧位对缩短手术时间、减少手术创伤有利。
Objective To compare the clinical effect of proximal femoral nail antirotation(PFNA) internal fixation in lateral decubitus position and supine position in the treatment of elderly patients with femoral intertrochanteric fractures. Methods A total of 160 patients with femoral intertrochanteric fractures treated in the Department of Orthopedics, Zhongshan Hospital of Traditional Chinese Medicine from October 2014 to October 2015 were slected as the research objects. According to randomly number table, they were divided into into two groups: control group and observation group, with 80 cases in each group. All patients were treated with PFNA internal fixation. The control group was treated in routine supine position, and the observation group was treated in lateral decubitus position. The clinical efficacy between the two groups were compared. The functional recovery of hip joint was evaluated according to Harris score after 1 year of follow-up. Results The incision length, operation time in the observation group were(4.72±1.78) cm,(41.72±12.36) min, respectively, which was significantly shorter than(6.28±2.95) cm,(55.29±27.42) min in the control group. The amount of hemorrhage in the observation group was(74.58±38.37) m L, which was significantly less than(104.53±45.29) m L in the control group(P<0.05). There was no significant difference in postoperative fracture healing time between the two groups(P>0.05). The complication rate in observation group and the control group were 8.75% and 11.25%, respectively, and the excellent and good rates of Harris hip joint function score1 year after operation were 95.00% and 91.25%, respectively, with no significant differences between the two groups(P>0.05). Conclusion PFNA is an effective surgical procedure for the treatment of elderly patients with femoral intertrochanteric fractures. Supine position and lateral decubitus position can both achieve good curative effect, but lateral decubitus position helps to shorten the operation time and reduce the operation wound.
Objective To compare the clinical effect of proximal femoral nail antirotation(PFNA) internal fixation in lateral decubitus position and supine position in the treatment of elderly patients with femoral intertrochanteric fractures. Methods A total of 160 patients with femoral intertrochanteric fractures treated in the Department of Orthopedics, Zhongshan Hospital of Traditional Chinese Medicine from October 2014 to October 2015 were slected as the research objects. According to randomly number table, they were divided into into two groups: control group and observation group, with 80 cases in each group. All patients were treated with PFNA internal fixation. The control group was treated in routine supine position, and the observation group was treated in lateral decubitus position. The clinical efficacy between the two groups were compared. The functional recovery of hip joint was evaluated according to Harris score after 1 year of follow-up. Results The incision length, operation time in the observation group were(4.72±1.78) cm,(41.72±12.36) min, respectively, which was significantly shorter than(6.28±2.95) cm,(55.29±27.42) min in the control group. The amount of hemorrhage in the observation group was(74.58±38.37) m L, which was significantly less than(104.53±45.29) m L in the control group(P<0.05). There was no significant difference in postoperative fracture healing time between the two groups(P>0.05). The complication rate in observation group and the control group were 8.75% and 11.25%, respectively, and the excellent and good rates of Harris hip joint function score1 year after operation were 95.00% and 91.25%, respectively, with no significant differences between the two groups(P>0.05). Conclusion PFNA is an effective surgical procedure for the treatment of elderly patients with femoral intertrochanteric fractures. Supine position and lateral decubitus position can both achieve good curative effect, but lateral decubitus position helps to shorten the operation time and reduce the operation wound.
引文
[1]辛健,汲长蛟,毕荣修,等.治疗老年股骨粗隆间骨折三种内固定方法的评价[J].中国矫形外科杂志,2012,20(12):1084-1087.
[2]侯国进,周方,张志山,等.不同内固定方式治疗老年股骨粗隆间骨折围手术期的失血特点分析[J].北京大学学报(医学版),2013,45(5):738-741.
[3]王国胜,魏宁波,曹明宇,等.人工股骨头置换与内固定治疗老年不稳定型股骨粗隆间骨折的系统评价[J].中国矫形外科杂志,2014,22(2):121-129.
[4]蒙芝健.老年股骨粗隆间骨折治疗方式的选择[J].海南医学,2013,24(9):1332-1335.
[5]高斌.老年股骨粗隆间骨折不同内固定治疗疗效观察[J].四川医学,2012,33(1):80-82.
[6]郭永智,桑庆华,于晨,等.PFNA与DHS内固定治疗骨质疏松性股骨粗隆间骨折的Meta分析[J].中国骨与关节损伤杂志,2014,29(6):537-540.
[7]李锐军,蔡荣辉,何智勇.全髋关节置换术后关节功能4种定量指标变化及Harris评分分析[J].中国骨科临床与基础研究杂志,2017,9(2):81-85.
[8]张伟强,祁宝昌,邓鹏飞,等.老年股骨粗隆间骨折治疗的临床进展[J].中国老年学杂志,2015,35(1):266-268.
[9]Zhang H,Zhu X,Pei G,et al.A retrospective analysis of the Inter Tan nail and proximal femoral nail anti-rotation in the treatment of intertrochanteric fractures in elderly patients with osteoporosis:a minimum follow-up of 3 years[J].J Orthop Surg Res,2017,12(1):147.
[10]袁晓明,姚琦,倪杰,等.股骨近端防旋髓内钉与动力髋螺钉治疗老年股骨粗隆间骨折的荟萃分析[J].中华医学杂志,2014,94(11):836-839.
[11]段文江,吴宇,赵红军,等.PFNA与DHS内固定治疗老年股骨粗隆间骨折疗效比较[J].创伤外科杂志,2013,15(1):41-44.
[12]潘富文,杜秀藩,张国如,等.PFNA治疗老年人股骨粗隆间骨折36例疗效观察[J].海南医学,2012,23(24):58-59.
[13]李意.股骨粗隆间骨折内固定手术治疗的研究进展[J].重庆医学,2013,42(10):1172-1175.
[14]殷勇,周贤杰.股骨近端抗旋髓内钉(PFNA)治疗老年不稳定股骨粗隆间骨折[J].中国骨与关节损伤杂志,2011,26(8):733-734.
[15]刘自强,李京蔚,程劲,等.侧卧位PFNA内固定治疗老年患者股骨粗隆间骨折的疗效体会[J].西南军医,2017,19(2):132-134.
[16]张瑞岭,郑建英,王任才,等.应用侧卧位行股骨近端防旋髓内钉治疗老年股骨粗隆间骨折效果观察[J].白求恩医学杂志,2016,14(6):762-764.
[2]侯国进,周方,张志山,等.不同内固定方式治疗老年股骨粗隆间骨折围手术期的失血特点分析[J].北京大学学报(医学版),2013,45(5):738-741.
[3]王国胜,魏宁波,曹明宇,等.人工股骨头置换与内固定治疗老年不稳定型股骨粗隆间骨折的系统评价[J].中国矫形外科杂志,2014,22(2):121-129.
[4]蒙芝健.老年股骨粗隆间骨折治疗方式的选择[J].海南医学,2013,24(9):1332-1335.
[5]高斌.老年股骨粗隆间骨折不同内固定治疗疗效观察[J].四川医学,2012,33(1):80-82.
[6]郭永智,桑庆华,于晨,等.PFNA与DHS内固定治疗骨质疏松性股骨粗隆间骨折的Meta分析[J].中国骨与关节损伤杂志,2014,29(6):537-540.
[7]李锐军,蔡荣辉,何智勇.全髋关节置换术后关节功能4种定量指标变化及Harris评分分析[J].中国骨科临床与基础研究杂志,2017,9(2):81-85.
[8]张伟强,祁宝昌,邓鹏飞,等.老年股骨粗隆间骨折治疗的临床进展[J].中国老年学杂志,2015,35(1):266-268.
[9]Zhang H,Zhu X,Pei G,et al.A retrospective analysis of the Inter Tan nail and proximal femoral nail anti-rotation in the treatment of intertrochanteric fractures in elderly patients with osteoporosis:a minimum follow-up of 3 years[J].J Orthop Surg Res,2017,12(1):147.
[10]袁晓明,姚琦,倪杰,等.股骨近端防旋髓内钉与动力髋螺钉治疗老年股骨粗隆间骨折的荟萃分析[J].中华医学杂志,2014,94(11):836-839.
[11]段文江,吴宇,赵红军,等.PFNA与DHS内固定治疗老年股骨粗隆间骨折疗效比较[J].创伤外科杂志,2013,15(1):41-44.
[12]潘富文,杜秀藩,张国如,等.PFNA治疗老年人股骨粗隆间骨折36例疗效观察[J].海南医学,2012,23(24):58-59.
[13]李意.股骨粗隆间骨折内固定手术治疗的研究进展[J].重庆医学,2013,42(10):1172-1175.
[14]殷勇,周贤杰.股骨近端抗旋髓内钉(PFNA)治疗老年不稳定股骨粗隆间骨折[J].中国骨与关节损伤杂志,2011,26(8):733-734.
[15]刘自强,李京蔚,程劲,等.侧卧位PFNA内固定治疗老年患者股骨粗隆间骨折的疗效体会[J].西南军医,2017,19(2):132-134.
[16]张瑞岭,郑建英,王任才,等.应用侧卧位行股骨近端防旋髓内钉治疗老年股骨粗隆间骨折效果观察[J].白求恩医学杂志,2016,14(6):762-764.