股骨近端防旋髓内钉联合环扎带固定治疗复杂股骨转子下骨折  

Effectiveness of proximal femoral nail anti-rotation and cerclage fixation for complicated femoral subtrochanteric fractures

作　　者：黄陈翼 高银 高海明 刘世贵 付至江 陈靖文 刘宗超 HUANG Chenyi;GAO Yi;GAO Haiming;LIU Shigui;FU Zhijiang;CHEN Jingwen;LIU Zongchao(Department of Orthopedic Surgery,the Affiliated Hospital of Traditional Chinese Medicine,Southwest Medical University,Luzhou Sichuan,646000,P.R.China)

机构地区：[1]西南医科大学附属中医医院骨伤科,四川泸州646000

出　　处：《中国修复重建外科杂志》2021年第8期956-960,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)联合环扎带固定治疗复杂股骨转子下骨折(SeinsheimerⅢ~Ⅴ型)的疗效。方法回顾分析2016年3月—2019年3月收治且符合选择标准的74例复杂股骨转子下骨折患者临床资料。其中,有限切开复位PFNA联合环扎带固定39例(观察组),闭合复位后单纯PFNA固定35例(对照组)。两组患者性别、年龄、致伤原因、骨折侧别及Seinsheimer分型以及受伤至手术时间等一般资料比较,差异均无统计学意义(P>0.05)。记录并比较两组术后1、3、5 d与术前血红蛋白的比值以及手术时间、患者术后首次下地负重时间、住院时间,定期复查X线片观察两组骨折愈合及观察组环扎带周围骨质吸收情况,记录骨折愈合时间;采用Harris评分评价髋关节功能。结果与对照组相比,观察组手术时间延长,但术后首次下地负重时间、住院时间均缩短,差异有统计学意义(P<0.05)。两组患者术后均获随访12个月。两组术后1、3、5 d与术前血红蛋白的比值比较,差异均无统计学意义(P>0.05)。X线片复查示两组骨折均顺利愈合,观察组骨折愈合时间较对照组缩短,差异有统计学意义(t=-12.989,P=0.000);观察组无环扎带周围骨质吸收情况。观察组术后7 d及1、2、3个月Harris评分均优于对照组(P<0.05),术后6个月两组比较差异无统计学意义(t=1.329,P=0.180)。结论与单纯PFNA固定相比,PFNA联合环扎带固定治疗复杂股骨转子下骨折具有手术时间短、固定后可获得即刻稳定性,满足患者早期功能锻炼需求等优点。Objective To investigate the effectiveness of proximal femoral nail anti-rotation(PFNA)and cerclage fixation for complicated femoral subtrochanteric fractures.Methods A clinical data of 74 patients with complicated femoral subtrochanteric fractures,who were admitted between March 2016 and March 2019 and met the criteria,was retrospectively analyzed.Among them,39 patients were treated with limited open reduction and PFNA combined with cerclage fixation(observation group)and 35 patients were treated with closed reduction and PFNA fixation(control group).There was no significant difference in gender,age,cause of injury,side and type of fracture,and the time from injury to operation(P>0.05).The ratio of postoperative hemoglobin(1,3,and 5 days)to the preoperative hemoglobin,the operation time,the first weight-bearing time after operation,and the hospital stay were recorded.X-ray films were taken to observe fracture healing in the two groups and bone resorption around the cerclage in the observation group,and the fracture healing time was recorded.Hip function was evaluated by Harris scoring.Results The operation time of the observation group was significantly longer than that of the control group(P<0.05),but the first weight-bearing time and hospital stay were significantly shorter(P<0.05).All patients were followed up 12 months.There was no significant difference in the ratios of post-to pre-operative hemoglobin(1,3,and 5 days)between the two groups(P>0.05).X-ray film reexamination showed that the fractures of the two groups healed smoothly,and the fracture healing time of the observation group was significantly shorter than that of the control group(t=-12.989,P=0.000).No bone resorption around the cerclage occurred in the observation group.The Harris scores of the observation group were better than those of the control group at 7 days and 1,2,and 3 months after operation(P<0.05),and there was no significant difference between the two groups at 6 months after operation(t=1.329,P=0.180).Conclusion Compared with PFNA f

关 键 词：股骨转子下骨折 股骨近端防旋髓内钉 环扎带 内固定 

分 类 号：R687.3[医药卫生—骨科学]