基于影像归档和通信系统测量标记导针长度在老年股骨近端抗旋髓内钉内固定术中的应用  

Measurement of the Length of Labeled Guide Pin Based on the Image Archiving and Communication System in the Internal Fixation of Proximal Femoral Anti-Rotation Intramedullary Nail in the Elderly

作　　者：熊斌 陆建平[1] 范永前[2] Xiong Bin;Lu Jianping;Fan Yongqian(Department of Operation Room,Huadong Hospital Affiliated to Fudan University,Shanghai,200040,P.R.China;Department of Orthopaedics,Huadong Hospital Affiliated to Fudan University,Shanghai,200040,P.R.China)

机构地区：[1]复旦大学附属华东医院手术室,上海200040 [2]复旦大学附属华东医院骨科,上海200040

出　　处：《老年医学与保健》2020年第3期421-424,共4页Geriatrics & Health Care

摘　　要：目的观察测量标记导针长度对老年股骨转子间骨折患者股骨近端抗旋髓内钉(PFNA)内固定手术的影响。方法2019年1月-6月,复旦大学附属华东医院采用PFNA内固定治疗的老年转子间骨折患者40例,随机分为观察组(n=20)和对照组(n=20)。观察组在术前通过影像归档和通信系统(PACS)测量健侧股骨颈长度,洗手护士术中根据术前测量长度在螺旋刀片的导针上用骨蜡做出标记,提示导针打入的长度;对照组行常规闭合复位内固定手术。记录并比较2组的手术时间、透视次数及术中出血量;随访术后第3天血红蛋白差值及围手术期并发症的发生率。结果观察组手术时间和透视次数少于对照组,差异有统计学意义(P<0.05);术中出血量少于对照组,但差异无统计学意义(P>0.05)。术后第3天,2组血红蛋白均较术前下降,2组血红蛋白差值差异无统计学意义(P>0.05)。2组深静脉血栓发生率差异无统计学意义(P>0.05),2组患者均未出现手术切口感染和肺部感染。结论基于PACS的测量数据进行导针长度标记,可以一定程度上减少PFNA内固定的术中透视次数,缩短手术时间,且不增加手术风险。Objective To observe the effect of the length of the labeled guide pin on the internal fixation of proximal femoral anti-rotation intramedullary nail(PFNA)in the elderly patients with intertrochanteric fracture of the femur.Methods40 elderly patients who received PFNA internal fixation operation from January to June 2019 in our hospital were enrolled and were divided randomly into experimental group(n=20)and control group(n=20).The control group received conventional closed reduction and internal fixation.In the observation group,the length of the contralateral femoral neck was measured by image archiving and communication system(PACS)before operation.The scrub nurse marked the guide pin with bone wax according to the length measured before operation to indicate the length of the guide needle.The operation duration,intraoperative fluoroscopy times and blood loss during operation were recorded and compared between two groups.The difference of hemoglobin on the third day after operation and the incidence of perioperative complications were compared between two groups.Results The operation duration and the intraoperative fluoroscopy times of the experimental group were less than those of control group(P<0.05).The amount of blood loss during operation in the observation group was less than that in the control group,but the difference was not statistically significant(P>0.05).On the third day after operation,hemoglobin in both groups was lower than that before operation,but there was no significant difference between two groups(P>0.05).There was no significant difference in the incidence of venous thrombosis between two groups(P>0.05);no surgical incision infection or lung infection occurred in both groups.Conclusions Marking the length of the guide pin based on the measurement data of PACS can reduce the intraoperative fluoroscopy times in PFNA internal fixation,shorten the operation duration,and do not increase the operation risk.

关 键 词：老年 股骨转子间骨折 股骨近端抗旋髓内钉 

分 类 号：R687.3[医药卫生—骨科学]