PFNA髓内固定与单边外支架治疗股骨粗隆间骨折的疗效比较  

Comparison of PFNA intramedullary fixation and unilateral external stent in treatment of femoral intertrochanteric fracture

作　　者：王丽平 Wang Liping(The Suqian Oriental Hospital of Jiangsu of Shanghai Oriental Hospital Group,Suqian 223800)

机构地区：[1]上海市东方医院集团宿迁市东方医院,江苏宿迁223800

出　　处：《中国伤残医学》2020年第2期1-3,共3页Chinese Journal of Trauma and Disability Medicine

摘　　要：目的:比较分析采用PFNA治疗及单边外支架闭合复位固定治疗股骨粗隆间骨折患者的疗效,并发症及预防措施.方法:高龄股骨粗隆间骨折患者50例,随机分2组,20例采取PFNA治疗,30例采用单边外支架固定治疗,对手术时间,术中及术后出血量,下床活动时间,治疗费用,发生术后并发症等方面进行比较.结果:外支架组手术时间短,平均时间为15-25(16.2±6.3)分钟,PFNA组25-40(27.2±6.5)分钟,术中出血外支架组10-25(11.3±7.2)ml,PFNA组200-300(241.0±25.0)ml,治疗费用外支架组平均比PFNA组少0.5万元.2组均于术后次日即可在床上坐起,下床活动时间根据患者自身身体情况,PFNA组平均6周左右,外支架组时间6-8周.外支架组5例出现钉孔红肿、渗液,经换药处理后均好转,1例于术后10个月发生钉孔感染,经换药于术后2个月去除外支架后愈合.其余24例外支架均于术后3个月去除,去除后钉孔均愈合良好.2组关节活动度均良好.结论:二者均为微创固定股骨粗隆间骨折的有效方法.PFNA固定可靠,效果满意,并发症发生率低,适用于各个年龄段的患者.外支架更适用高龄、高危、手术耐受能力差患者的治疗.Objective:To compare and analyze the efficacy,complications and preventive measures of PFNA and closed reduction and fixation with unilateral external stent in the treatment of intertrochanteric fracture of femur.Methods:50 elderly patients with intertrochanteric fracture of femur were randomly divided into two groups,20 patients were treated with PFNA and 30 patients were treated with unilateral external stent fixation.The operation time,intraoperative and postoperative bleeding volume,time of getting out of bed,treatment cost and complications were compared.Results:The operation time of the external stent group was shorter,the average time was 15-25(16.2±6.3)minutes,25-40(27.2±6.5)minutes in the PFNA group,10-25(11.3±7.2)ml in the bleeding external stent group,200-300(241.0±25.0)ml in the PFNA group,and the treatment cost of the external stent group was 0.5 million yuan less than that of the PFNA group.Both groups could sit up in bed the next day after operation.The time of getting out of bed was about 6 weeks in PFNA group and 6-8 weeks in external stent group.In the external stent group,5 cases had pinhole swelling and exudation,which were all improved after dressing change,1 case had pinhole infection in one month after operation,and healed after removing the external stent two months after dressing change.The other 24 stents were removed 3 months after operation,and the nail holes healed well after removal.Both groups had good range of motion.Conclusion:Both of them were effective methods for minimally invasive fixation of intertrochanteric fracture of femur.PFNA fixation was reliable,the effect was satisfactory,and the incidence of complications is low.It was suitable for patients of all ages.External stents were more suitable for the treatment of elderly,high-risk patients with poor surgical tolerance.

关 键 词：股骨粗隆间骨折 高龄 单边外支架 PFNA 

分 类 号：R683.42[医药卫生—骨科学]