骨科牵引床“剪刀体位”辅助下PFNA治疗老年股骨粗隆间骨折的效果
|
摘要
目的探讨骨科牵引床"剪刀体位"辅助下近端防旋髓内钉(PFNA)治疗老年股骨粗隆间骨折的效果。方法选择2015年8月至2018年3月在我院行股骨粗隆间骨折牵引床闭合复位PFNA内固定的80例患者为研究对象,将其随机分为A组(38例,骨科牵引床健侧"截石位")与B组(42例,骨科牵引床"剪刀体位")。比较两组患者术中相关指标、术后3、6个月Harris评分及术后健侧疼痛不适发生情况。结果 B组的术前体位摆放时间及手术时间均短于A组,术中C臂透视次数少于A组,差异均具有统计学意义(P<0.05);两组术中显性失血量比较,差异不具有统计学意义(P>0.05)。术后3、6个月,B组的Harris评分均高于A组,差异具有统计学意义(P<0.05)。B组术后健侧肢体疼痛发生率略低于A组,差异无统计学意义(P>0.05)。结论骨科牵引床剪刀体位下PFNA内固定治疗老年股骨粗隆间骨折的术前摆放体位时间短、手术时间短、术中C臂透视次数少、术后健侧疼痛不适感低、安全性高,临床实用性高,值得在老年股骨粗隆间骨折手术中推广使用。
Objective To explore the effect of proximal femoral nail anti-rotation(PFNA) assisted by orthopaedic traction bed "scissors position" in the treatment of intertrochanteric fractures of femur in the elderly. Methods Eighty patients treated by closed reduction with traction bed and PFNA internal fixation for intertrochanteric fractures of femur from August 2015 to March 2018 in our hospital were randomly divided into group A(38 cases, healthy side "lithotomy position" of orthopaedic traction bed) and group B(42 cases, "scissors position" of orthopaedic traction bed). The relevant indexes during operation, Harris score at 3 and 6 months after operation and occurrence of pain and discomfort on the healthy side were compared between the two groups. Results The preoperative position placement time and operation time of the group B were shorter than those of the group A, and the number of C-arm fluoroscopy during operation was less than that of the group A, the differences were statistically significant(P <0.05); there was no significant difference in the intraoperative blood loss amount between the two groups(P>0.05). The Harris scores at 3 and 6 months after operation of the group B were higher than those of the group A, and the differences were statistically significant(P<0.05). The incidence of pain on the healthy side in the group B was slightly lower than that in the group A, and the difference was not statistically singnificant(P >0.05). Conclusion PFNA assisted by orthopaedic traction bed scissors position in the treatment of intertrochanteric fractures of femur in the elderly has the advantages of short preoperative position placement time, short operation time, less C-arm fluoroscopy times during the operation, low discomfort on the healthy side after the operation, high safety and high clinical practicability. It is worth popularizing in the operation of intertrochanteric fractures of femur in the elderly.
Objective To explore the effect of proximal femoral nail anti-rotation(PFNA) assisted by orthopaedic traction bed "scissors position" in the treatment of intertrochanteric fractures of femur in the elderly. Methods Eighty patients treated by closed reduction with traction bed and PFNA internal fixation for intertrochanteric fractures of femur from August 2015 to March 2018 in our hospital were randomly divided into group A(38 cases, healthy side "lithotomy position" of orthopaedic traction bed) and group B(42 cases, "scissors position" of orthopaedic traction bed). The relevant indexes during operation, Harris score at 3 and 6 months after operation and occurrence of pain and discomfort on the healthy side were compared between the two groups. Results The preoperative position placement time and operation time of the group B were shorter than those of the group A, and the number of C-arm fluoroscopy during operation was less than that of the group A, the differences were statistically significant(P <0.05); there was no significant difference in the intraoperative blood loss amount between the two groups(P>0.05). The Harris scores at 3 and 6 months after operation of the group B were higher than those of the group A, and the differences were statistically significant(P<0.05). The incidence of pain on the healthy side in the group B was slightly lower than that in the group A, and the difference was not statistically singnificant(P >0.05). Conclusion PFNA assisted by orthopaedic traction bed scissors position in the treatment of intertrochanteric fractures of femur in the elderly has the advantages of short preoperative position placement time, short operation time, less C-arm fluoroscopy times during the operation, low discomfort on the healthy side after the operation, high safety and high clinical practicability. It is worth popularizing in the operation of intertrochanteric fractures of femur in the elderly.
引文
[1]胥少汀,葛宝丰,徐印坎.实用骨科学[M].4版.北京:人民军医出版社,2012:947-958.
[2]SADOWSKI C,L譈BBEKE A,SAUDAN M,et al.Treatment of reverse oblique and transverse intertrochanteric fractures with use of an intramedullary nail or a 95 degrees screw-plate:a prospective,randomized study[J].J Bone Joint Surg Am,2002,84-A(3):372-381.
[3]彭维波,农林,韦仕战,等.Gamma钉与动力髋螺钉治疗股骨转子间骨折的Meta分析[J].中国组织工程研究与临床康复,2011,15(43):8108-8111.
[4]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.
[5]HSUEH KK,FANG CK,CHEN CM,et al.Risk factors in cutout of sliding hip screw in intertrochanteric farctures:an evaluation of 937patients[J].Int Orthop,2010,34(8):1273-1276.
[6]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.
[7]曹兴兵,孙继芾,许腊梅,等.PFNA治疗股骨粗隆间骨折内固定失败的多因素分析[J].中国骨与关节损伤杂志,2016,31(10):1034-1038.
[8]刘云鹏,刘沂.骨与关节损伤和疾病的诊断分类及功能评定标准[M].北京:清华大学出版社,2002:72-73.
[9]龚江浩.股骨近端防旋髓内钉联合抗骨质疏松药物治疗不稳定型老年股骨转子间骨折的临床观察[J].中医正骨,2015,27(4):29-32.
[10]KRISTENSEN MT.Anaemia impedes functional mobility after hip fracture surgery[J].Age Ageing,2008,37(2):173-178.
[11]王智,任平,王杰,等.三种内固定方法治疗老年人骨质疏松性股骨粗隆间骨折的优缺点分析[J].海南医学,2015,23(1):31-33.
[12]沈宁江,林坚平,王广积,等.老年股骨转子间骨折不同手术方法比较研究[J].实用骨科杂志,2016,22(1):6-10.
[13]秦宏敏,刘汉涛,余东洋.高龄股骨粗隆间骨折手术治疗生存率分析[J].中国矫形外科杂志,2017,25(2):123-125.
[14]朱卫洁,王晓芳,申友亮,等.早期闭合复位PFNA内固定治疗老年股骨转子间骨折[J].中国矫形外科杂志,2018,26(6):520-523.
[15]STRAUSS E,FRANK J,LEE J,et al.Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures:a biomechanical evaluation[J].Injury,2006,37(10):984-989.
[16]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.
[17]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.
[18]杜世浩,印飞,韦旭明,等.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[J].中国修复重建外科杂志,2016,30(2):152-155.
[19]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 Journal,2013:1-7.
[2]SADOWSKI C,L譈BBEKE A,SAUDAN M,et al.Treatment of reverse oblique and transverse intertrochanteric fractures with use of an intramedullary nail or a 95 degrees screw-plate:a prospective,randomized study[J].J Bone Joint Surg Am,2002,84-A(3):372-381.
[3]彭维波,农林,韦仕战,等.Gamma钉与动力髋螺钉治疗股骨转子间骨折的Meta分析[J].中国组织工程研究与临床康复,2011,15(43):8108-8111.
[4]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.
[5]HSUEH KK,FANG CK,CHEN CM,et al.Risk factors in cutout of sliding hip screw in intertrochanteric farctures:an evaluation of 937patients[J].Int Orthop,2010,34(8):1273-1276.
[6]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.
[7]曹兴兵,孙继芾,许腊梅,等.PFNA治疗股骨粗隆间骨折内固定失败的多因素分析[J].中国骨与关节损伤杂志,2016,31(10):1034-1038.
[8]刘云鹏,刘沂.骨与关节损伤和疾病的诊断分类及功能评定标准[M].北京:清华大学出版社,2002:72-73.
[9]龚江浩.股骨近端防旋髓内钉联合抗骨质疏松药物治疗不稳定型老年股骨转子间骨折的临床观察[J].中医正骨,2015,27(4):29-32.
[10]KRISTENSEN MT.Anaemia impedes functional mobility after hip fracture surgery[J].Age Ageing,2008,37(2):173-178.
[11]王智,任平,王杰,等.三种内固定方法治疗老年人骨质疏松性股骨粗隆间骨折的优缺点分析[J].海南医学,2015,23(1):31-33.
[12]沈宁江,林坚平,王广积,等.老年股骨转子间骨折不同手术方法比较研究[J].实用骨科杂志,2016,22(1):6-10.
[13]秦宏敏,刘汉涛,余东洋.高龄股骨粗隆间骨折手术治疗生存率分析[J].中国矫形外科杂志,2017,25(2):123-125.
[14]朱卫洁,王晓芳,申友亮,等.早期闭合复位PFNA内固定治疗老年股骨转子间骨折[J].中国矫形外科杂志,2018,26(6):520-523.
[15]STRAUSS E,FRANK J,LEE J,et al.Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures:a biomechanical evaluation[J].Injury,2006,37(10):984-989.
[16]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.
[17]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.
[18]杜世浩,印飞,韦旭明,等.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[J].中国修复重建外科杂志,2016,30(2):152-155.
[19]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 Journal,2013:1-7.