经皮导入导针结合纯侧位透视简化股骨近端防旋髓内钉操作  

Applying percutaneous placement of guide wire combined with true lateral view fluoroscopy proximal femoral nail anti-rotation fixation

作　　者：杨明[1] 张晓萌[1] 张培训[1] 王天兵[1] 傅中国[1] 张殿英[1] 姜保国[1] 

机构地区：[1]北京大学人民医院创伤骨科北京大学交通医学中心,北京100044

出　　处：《北京大学学报（医学版）》2015年第2期258-262,共5页Journal of Peking University:Health Sciences

基　　金：教育部创新团队发展计划项目(IRT1201);北京大学人民医院研究与发展基金(RDB2014-01)资助~~

摘　　要：目的:探讨在股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)治疗股骨转子间骨折的手术中,应用改良的经皮导入主钉导针结合纯侧位透视技术,简化PFNA操作步骤。方法:选择2011年3月至2014年5月在北京大学人民医院创伤骨科,采用常规PFNA内固定技术与改良的经皮导入导针结合纯侧卧透视的PFNA内固定技术治疗股骨转子间骨折病例进行回顾性分析,对随访到的共60例患者,分析其手术时间、术中出血量、术中透视时间、尖顶距、骨折愈合时间和髋关节评分等指标。结果:经皮导入导针结合纯侧卧透视的改良PFNA内固定组的手术时间、术中出血量和术中透视时间分别为(70.5±12.5)min、(34.9±6.1)m L、(63.6±9.7)s,常规PFNA内固定组则为(80.6±17.1)min、(47.8±6.7)m L、(68.5±8.7)s,两组之间差异有统计学意义(P分别为0.006、0.013、0.022)。在尖顶距、术后髋关节功能和骨折愈合时间等方面,两组之间差异无统计学意义(P>0.05)。结论:转子尖处的骨折线对于部分转子间骨折可能是一个天然的进针点,经皮先导入主钉导针结合术中纯侧位透视,可明显减少手术时间、出血量和术中透视时间,使PFNA操作更简单有效。Objective：To apply modified proximal femoral nail anti-rotation （ PFNA ） fixation tech-niques performed by percutaneous placement of guide wire combined with true lateral view and to make the procedures simpler.Methods：A retrospective study was used to analyze the clinical data of femoral intertrochanteric fractures cases, which were treated with conventional PFNA fixation or modified PFNA fixation performed by percutaneous placement guide wire combined with true lateral view in our hospital, from March, 2011 to May, 2014.In the study, 60 cases were followed for average 13 months.The oper-ation time, the amount of bleeding, the fluoroscopy time, postoperative radiographic measurements （ tip apex distance, TAD ） and hip function scores were analyzed.Results：In modified PFNA group, the amount of bleeding, the operation time and the fluoroscopy time were （70.5 ±12.5） min, （34.9 ±6.1） mL, （ 63.6 ±9.7 ） s respectively.In conventional PFNA group, they were （ 80.6 ±17.1 ） min, （47.8 ±6.7） mL, （68.5 ±8.7） s respectively.There were significant differences in the above respects between the two groups （P were 0.006, 0.013, and 0.022 respectively）.There were no significant differences in TAD, fracture healing time, postoperative hip scores between the two groups （P〉0.05）. Conclusion：Fracture line is a natural entry point for some cases of femoral intertrochanteric fractures when we use proximal femoral nail anti-rotation to fix the fracture.Applying percutaneous insertion of the guide pin combined with true lateral view could reduce the operation time, amount of bleeding, and fluo-roscopy time significantly, make the procedures simpler and acquire satisfactory results .

关 键 词：股骨骨折 骨折固定术 髓内 骨钉 

分 类 号：R683.42[医药卫生—骨科学]