仰卧“剪刀”体位对股骨近端防旋髓内钉治疗股骨转子间骨折的疗效影响
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摘要
目的探讨仰卧"剪刀"体位对股骨近端防旋髓内钉治疗股骨转子间骨折的疗效影响。方法 2016年1月—2018年1月重庆市万州区第一人民医院骨科收治70例老年股骨转子间骨折患者,男性30例,女性40例;年龄63～81岁,平均69.81岁。根据手术体位分为仰卧"剪刀"体位组(剪刀位组)和仰卧单腿截石位组(截石位组)各35例。比较两组患者切口大小、手术出血量、手术时间、住院和骨折愈合时间、并发症发生率等指标以及术后3、6、12个月以及末次随访Harris髋关节评分。结果患者均获随访12～25个月,平均16.75个月;剪刀位组切口长度(4.89±2.15)cm、住院时间(8.35±1.92)d、骨折愈合时间(9.80±1.63)周,术后3、6、12个月以及末次随访Harris髋关节评分与截石位组相比,差异无统计学意义(P>0.05);剪刀位组手术时间(37.92±6.91)min、出血量(102.81±9.09)mL、透视次数(10.22±3.03)少于截石位组,差异有统计学意义(P<0.05);剪刀位组患者并发症发生率(2.86%)低于截石位组(17.14%),差异有统计学意义(P<0.05)。结论仰卧"剪刀"体位治疗股骨转子间骨折能够减少患者术中出血量,缩短手术时间,降低术后并发症发生率,推荐临床应用。
Objective To investigate the effect of supine "scissors" position on proximal femoral anti-rotation intramedullary nail in the treatment of femoral intertrochanteric fracture. Methods Totally 70 elderly patients with femoral intertrochanteric fractures treated in Department of Orthopedics,The First People's Hospital of Wanzhou District from Jan. 2016 to Jan. 2018 were selected as objects. There were 30 males and 40 females aged 69.81(63-81) years. According to the operative position,the patients were divided into the supine "scissors" position group(observation group) and the supine one-leg lithotomy position group(control group) with 35 cases in each group. The incision size,operative blood loss and time,hospitalization and fracture healing time,complication rate and Harris score at 3,6 and 12 months postoperatively were compared. Results All patients were followed up for 12-25 months,with an average of 16.75 months. Compared with the control group,there was no significant difference in incision,fracture healing time and postoperative hip joint scoring system(Harris) score between the observation group and the control group(P>0.05).Operation time(37.92± 6.91) min,blood loss(102.81±9.09) mL,fluoroscopy(10.22±3.03) times in the observation group were less than those in the control group,and the difference was statistically significant(P<0.05). The incidence of complications in the observation group was 2.86%,lower than that in the control group(17.14%),and the difference was statistically significant(P<0.05). Conclusion The supine "scissors" position in the treatment of femoral intertrochanteric fracture can reduce intraoperative bleeding,shorten the operation time and reduce postoperative complications,and is recommended for clinical application.
Objective To investigate the effect of supine "scissors" position on proximal femoral anti-rotation intramedullary nail in the treatment of femoral intertrochanteric fracture. Methods Totally 70 elderly patients with femoral intertrochanteric fractures treated in Department of Orthopedics,The First People's Hospital of Wanzhou District from Jan. 2016 to Jan. 2018 were selected as objects. There were 30 males and 40 females aged 69.81(63-81) years. According to the operative position,the patients were divided into the supine "scissors" position group(observation group) and the supine one-leg lithotomy position group(control group) with 35 cases in each group. The incision size,operative blood loss and time,hospitalization and fracture healing time,complication rate and Harris score at 3,6 and 12 months postoperatively were compared. Results All patients were followed up for 12-25 months,with an average of 16.75 months. Compared with the control group,there was no significant difference in incision,fracture healing time and postoperative hip joint scoring system(Harris) score between the observation group and the control group(P>0.05).Operation time(37.92± 6.91) min,blood loss(102.81±9.09) mL,fluoroscopy(10.22±3.03) times in the observation group were less than those in the control group,and the difference was statistically significant(P<0.05). The incidence of complications in the observation group was 2.86%,lower than that in the control group(17.14%),and the difference was statistically significant(P<0.05). Conclusion The supine "scissors" position in the treatment of femoral intertrochanteric fracture can reduce intraoperative bleeding,shorten the operation time and reduce postoperative complications,and is recommended for clinical application.
引文
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[8] 薛启明,陈卫东,王瑞平,等.剪刀体位下行标准γ-Ⅲ型髓内钉治疗股骨转子间骨折[J].临床骨科杂志,2015,18(3):381.
[9] 刘景一,杨晓飞,贺新兵,等.股骨近端螺旋刀片抗旋髓内钉治疗股骨粗隆间骨折的并发症及其防治[J].中国矫形外科杂志,2014,360(22):2105-2107.
[10] 杨昌琴,印飞.仰卧“剪刀”体位在老年股骨转子间骨折病人术中的应用[J].护理研究,2017,31(16):2047-2048.
[11] Roberts KC,Brox WT,Jevsevar DS,et al.Management of hip fractures in the elderly[J].J Am Acad Orthop Surg,2015,23(2):131-137.
[12] 曾晶山,蔡贤华,李稳,等.老年股骨转子间骨折围手术期隐性失血量与性别、内固定方式的相关性分析[J].中华创伤骨科杂志,2015,17(2):134-137
[13] Xue L,Zha L,Chen Q,et al.Randomized controlled trials of proximal femoral nail antirotation in lateral decubitus and supine position on treatment of intertrochanteric fractures[J].Scientific World J,2013,2013:276015.
[14] 陈卫东,薛启明,王瑞平,等.剪刀位与单腿截石位行股骨近端防旋髓内钉内固定治疗股骨转子间骨折[J].临床骨科杂志,2018,21(2):255-256.
[2] 刘冰,赵亮亮,朱云龙,等.DHS、PFNA 内固定治疗老年股骨粗隆间骨折的临床疗效及安全性分析[J].中国医刊,2017,52(7):84- 87.
[3] 冯暘,陈斌,张焱,等.半髋置换与股骨近端防旋髓内钉治疗股骨粗隆间骨折的比较[J].中国矫形外科杂志,2017,25(12):1081- 1085.
[4] Sambandam SN,Chandrasekharan J,Mounasamy V,et al.Intertrochanteric fractures:a review of fixation methods [J].Eur J Orthop Traumatol,2016,26(4):339-353.
[5] 刘宪昌.体位对股骨近端防旋髓内钉(PFNA)内固定治疗不稳定股骨粗隆间骨折疗效的影响[J].创伤外科杂志,2016,18(10):620- 621.
[6] Zhang L,Shen J,Chen S,et al.Treatment of unstable intertrochanteric femoral fractures with locking gamma nail(LGN):a retrospective cohort study[J].Int J Surg,2016,26:12-17.
[7] Sanders D,Bryant D,Tieszer C,et al.A multicenter randomized control trial comparing a novel intramedullary device (InterTAN) versus conventional treatment (sliding hip screw) of geriatric hip fractures[J].J Orthop Trauma,2017,31(1):1-8.
[8] 薛启明,陈卫东,王瑞平,等.剪刀体位下行标准γ-Ⅲ型髓内钉治疗股骨转子间骨折[J].临床骨科杂志,2015,18(3):381.
[9] 刘景一,杨晓飞,贺新兵,等.股骨近端螺旋刀片抗旋髓内钉治疗股骨粗隆间骨折的并发症及其防治[J].中国矫形外科杂志,2014,360(22):2105-2107.
[10] 杨昌琴,印飞.仰卧“剪刀”体位在老年股骨转子间骨折病人术中的应用[J].护理研究,2017,31(16):2047-2048.
[11] Roberts KC,Brox WT,Jevsevar DS,et al.Management of hip fractures in the elderly[J].J Am Acad Orthop Surg,2015,23(2):131-137.
[12] 曾晶山,蔡贤华,李稳,等.老年股骨转子间骨折围手术期隐性失血量与性别、内固定方式的相关性分析[J].中华创伤骨科杂志,2015,17(2):134-137
[13] Xue L,Zha L,Chen Q,et al.Randomized controlled trials of proximal femoral nail antirotation in lateral decubitus and supine position on treatment of intertrochanteric fractures[J].Scientific World J,2013,2013:276015.
[14] 陈卫东,薛启明,王瑞平,等.剪刀位与单腿截石位行股骨近端防旋髓内钉内固定治疗股骨转子间骨折[J].临床骨科杂志,2018,21(2):255-256.