摘要
目的比较侧卧位与仰卧位股骨近端防旋髓内钉（PFNA）固定治疗股骨转子间骨折的疗效。方法回顾性分析2013年9月至2014年9月期间收治的85例股骨转子间骨折患者资料，男24例，女61例；年龄为28～99岁，平均78．5岁；骨折按Evans．Jensen分型：I型I例，Ⅱ型15例，Ⅲ型40例，Ⅳ型23例，V型6例。所有患者均采用PFNA固定治疗，根据患者体位不同分为两组：侧卧位组45例，仰卧位组40例，比较两组患者的手术时间、术中出血量、术前术后血红蛋白差值、术后尖顶距、股骨距．尖顶距、骨折愈合时间及髋关节Harris评分等。结果85例患者术后获9～21个月（平均13．6个月）随访。两组患者骨折均获愈合，无一例患者发生螺钉切出。侧卧位组患者手术时间[（60．3±17．5）min】、术中出血量[（70．8±37．8）mL】显著少于仰卧位组患者【（72．7±19．7）min、（90．3±20．9）mL】，术前术后血红蛋白差值【（24．1±5．7）g／L】显著低于仰卧位组患者[（28．2±8．5）g／L】，差异均有统计学意义（P〈0．05）。而两组患者术后尖顶距、股骨距．尖顶距等比较差异均无统计学意义（P〉0．05）。侧卧位组与仰卧位组患者骨折愈合时间平均分别为（3．7±0．9）、（3．7±1．0）个月，髋关节Harris评分平均分别为（73．4±10．7）、（75．5±9．5）分，差异均无统计学意义（P〉0．05）。结论侧卧位PFNA固定治疗股骨转子间骨折较仰卧位手术时间明显缩短、术中出血量减少。
Objective To compare the lateral decubitus and supine position in the treatment of femoral intertrochanteric fractures with femoral proximal nail antirotation （PFNA） . Methods A retrospective analysis was performed of the 85 patients with intertroehanteric fracture who had been treated at our hospital between September 2013 and September 2014. They were 24 men and 61 women, 28 to 99 years of age （average, 78.5 years）. By Evans-Jensen classification, one ease was type Ⅰ, 15 eases were type Ⅱ, 40 type Ⅱ, 23 type Ⅳ, and 6 type V. All the patients were treated with internal fixation with PFNA. Lateral decubitus position was adopted in 45 cases and supine position in 40. The 2 groups were compared in terms of operation time, intraoperative bleeding volume, difference between preoperative and postoperative hemoglobin values, tip-apex distance （TAD）, ealear tip-apex distance （Cal-TAD）, fracture healing time, and Harris score of the hip joint. Results The 85 patients were followed up for 9 to 21 months （average, 13.6 months）. Both 2 groups obtained fracture healing, with no screw cut-out. The lateral decubitus group had significantly less operation time （60. 3± 17.5 rain） and intraoperative bleeding volume （70. 8 ± 37.8 mL） than the supine position group （72. 7 ± 19.7 min and 90. 3 ± 20. 9 mL, respectively） （ P 〈 0.05） . The former also had a significantly smaller difference between preoperative and postoperative hemoglobin values （24. 1 ± 5.7 g/L） than the latter （28.2 ± 8.5 g/L） （ P 〈 0. 05） . There were no significant differences between the 2 groups in TAD, Cal-TAD, fracture healing time （3.7 ±0. 9 months versus 3.7 ± 1.0 months）, or Harris hip score （73.4±10.7versus75.5±9.5） （P〉 0.05） . Conclusion In the treatment of femoral intertrochanterie fractures with PFNA, lateral decubitus position may be associated with shorter op- eration time and less intraoperative blood loss compared with supine position.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2016年第5期401-406,共6页
Chinese Journal of Orthopaedic Trauma
基金
上海市科委基金（15DZ2343200）
关键词
髋骨折
骨折固定术
髓内
骨钉
体位
Hip fractures
Fracture fixation, intramedullary
Bone nails
Position
