无牵引床仰卧位不扩髓与扩髓股骨近端防旋髓内钉内固定治疗老年股骨转子间骨折的比较研究  

A comparative study of unreamed versus reamed proximal femoral nail antirotation internal fixation in the supine position without traction table for treatment of intertrochanteric fractures in the aged

作　　者：陆洲 孙奇 裘晓冬 骆志航 任雅春 LU Zhou SUN Qi QIU Xiaodong LUO Zhihang REN Yachun(Fuyang TCM Orthopedic - Traumatological Hospital, Hangzhou 311400, Zhejiang, China)

机构地区：[1]浙江省杭州市富阳中医骨伤医院,浙江杭州311400

出　　处：《中医正骨》2017年第9期15-18,27,共5页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:比较无牵引床仰卧位不扩髓与扩髓股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定治疗老年股骨转子间骨折的临床疗效。方法:回顾性分析120例老年股骨转子间骨折患者的病例资料,其中采用无牵引床仰卧位不扩髓PFNA内固定60例,无牵引床仰卧位扩髓PFNA内固定60例。男51例,女69例。年龄75~93岁,中位数83岁。按照股骨转子间骨折的AO分型,稳定型(A1型和A2.1型)20例、不稳定型(A2.2型、A2.3型和A3型)100例。合并1种内科疾病17例、2种内科疾病74例、2种以上内科疾病29例。受伤至手术时间1~7 d,中位数4 d。比较2组患者手术时间、术中失血量及隐性失血量,并于术后3个月比较2组患者Harris髋关节评分。结果:不扩髓组术中失血量和隐性失血量均小于扩髓组[(105.40±26.40)mL,(156.30±38.50)mL,t=8.580,P=0.000;(280.60±98.20)mL,(320.50±115.30)mL,t=2.051,P=0.043],手术时间短于扩髓组[(76.40±13.10)min,(85.30±16.20)min,t=3.382,P=0.001];术后3个月,2组患者Harris髋关节评分比较,差异无统计学意义[(83.80±14.70)分,(85.60±15.30)分,t=0.657,P=0.512]。结论:对于老年股骨转子间骨折患者而言,在髋关节功能恢复方面,无牵引床仰卧位不扩髓PFNA内固定与扩髓PFNA内固定无明显差异,但不扩髓PFNA内固定较扩髓PFNA内固定的手术时间短、失血量少,符合老年患者的治疗要求,可作为临床治疗老年股骨转子间骨折的一种较为理想的选择。Objective ：To compare the clinical curative effect of unreamed versus reamed proximal femoral nail antirotation （PFNA） in- ternal fixation in the supine position without traction table in the treatment of intertrochanterlc fractures in the aged. Methods：The medical records of 120 aged patients with intertroehanterie fractures were analyzed retrospectively. Sixty patients were treated with unreamed PFNA internal fixation in the supine position without traction table（ group A） ,while the others were treated with reamed PFNA internal fixation in the supine position without traction table（group B）. The patients consisted of 51 males and 69 females,and ranged in age from 75 to 93 years （Median = 83 yrs ）. According to AO classification of intertrochanteric fractures, the fractures belonged to stable -type（ AI and A2.1 ） in 20 cases and unstable - type （ A2.2, A2.3 and A3 ） in 100 cases. Seventeen patients had one kind of morbus internus, and 74 patients had two kinds of morbus internus, and 29 patients had more than 2 kinds of morbus internus. The patients ranged in disease course from 1 to 7 days（ Median =4 days）. The operative time ,intraoperative blood loss and hidden blood loss were compared between the 2 groups, and the Harris hip scores were compared between the 2 groups at 3 months after the surgery. Results：The intraoperative blood loss and hidden blood loss were less and the operative time was shorter in group A compared to group B （ 105.40 ＋/- 26.40 vs 156.30 ＋/- 38.50 ml, t = 8. 580, P =0. 000;280.60 ＋/-98.20 vs 320.50 ＋/- 115.30 ml,t =2. 051 ,P =0.043 ;76.40 ＋/- 13.10 vs 85.30 ＋/- 16.20 min,t = 3. 382 ,P = 0. 001 ）. There was no statistical difference in the Harris hip scores between the 2 groups at 3 months after the surgery（83.80 ＋/- 14.70 vs 85.60 ＋/-15.30 points, t = 0. 657, P = 0.512 ）. Conclusion：For aged patients with intertrochanteric fractures, there are no significant difference in hip joint functional recovery between unreamed and reame

关 键 词：髋骨折 转子间骨折 骨折固定术 髓内 老年人 

分 类 号：R687.3[医药卫生—骨科学]