仰卧“剪刀”体位与单腿截石位结合股骨近端防旋髓内钉治疗老年股骨粗隆骨折疗效比较

发布时间：2018-06-13 07:07

本文选题：股骨粗隆骨折 + 内固定　；参考：《中国修复重建外科杂志》2016年02期

【摘要】：目的比较仰卧"剪刀"体位与单腿截石位行股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定治疗老年股骨粗隆骨折的临床疗效。方法回顾性分析2013年1月-2015年1月应用PFNA内固定治疗的58例老年股骨粗隆骨折患者临床资料,根据体位不同分为仰卧单腿截石位组(A组28例)与仰卧"剪刀"体位组(B组30例)。两组患者性别、年龄、侧别、致伤原因、骨折分型、受伤至手术时间等一般资料比较差异均无统计学意义(P0.05),具有可比性。记录手术切口长度、手术时间、术中透视次数、术中出血量、术中及术后并发症发生情况、骨折愈合时间,末次随访时采用髋关节Harris评分评价临床疗效。结果术后切口均Ⅰ期愈合,无感染、压疮、下肢深静脉血栓形成等并发症发生。两组手术切口长度比较差异无统计学意义(t=1.313,P=0.212);A组术中出血量、手术时间及术中透视次数均多于B组(P0.05)。两组患者均获随访,随访时间10~31个月,平均15.3个月。A组1例术后健侧肢体肌肉牵拉损伤,5例术后会阴部不适;其余患者均未发生手术相关并发症。两组患者骨折愈合时间及末次随访时髋关节Harris评分比较,差异均无统计学意义(P0.05)。结论与仰卧单腿截石位相比,"剪刀"体位下行PFNA内固定治疗老年股骨粗隆骨折具有手术时间短、术中透视及出血少、术后并发症少等优点,疗效确切。
[Abstract]:Objective to compare the clinical effect of supine "scissors" position and single leg lithotomy in the treatment of femoral trochanteric fractures with proximal femoral nail antirotation PFNAs. Methods the clinical data of 58 elderly patients with femoral trochanteric fracture treated with PFNA internal fixation from January 2013 to January 2015 were retrospectively analyzed. According to their different positions, they were divided into group A (n = 28) and group B (n = 30). There were no significant differences in sex, age, side, cause of injury, fracture classification, injury time to operation between the two groups (P 0.05). The length of incision, the time of operation, the times of fluoroscopy, the amount of intraoperative bleeding, the incidence of intraoperative and postoperative complications, the time of fracture healing were recorded. Harris score of hip joint was used to evaluate the clinical efficacy at the last follow-up. Results all the incisions healed without infection, pressure sore, deep vein thrombosis and so on. There was no significant difference in the length of incision between the two groups. The amount of blood loss, the operation time and the times of fluoroscopy in group A were more than those in group B (P 0.05). All the patients in both groups were followed up for 10 ~ 31 months (mean 15.3 months). In group A, there was no postoperative perineum discomfort in 5 patients with contralateral limb muscle stretch injury. There was no significant difference in the fracture healing time and Harris score of hip joint between the two groups at the last follow-up (P 0.05). Conclusion compared with supine single leg lithotomy, PFNA internal fixation in the position of "scissors" has the advantages of short operation time, less intraoperative fluoroscopy and less bleeding, less postoperative complications and so on.
【作者单位】：苏州大学附属无锡市第九人民医院骨科;
【分类号】：R687.3

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