侧卧位有限切开治疗股骨粗隆骨折的体会  

Experience of lateral decubitus limited incision in treatment of femoral trochanteric fracture

作　　者：周立平[1] 孙煜[1] 于万涛 ZHOU Liping;SUN Yu;YU Wantao(Department of Osteoarthrosis,Changzhou First People’s Hospital,Changzhou,Jiangsu 213003,China)

机构地区：[1]常州市第一人民医院骨关节科,江苏常州213003

出　　处：《手术电子杂志》2022年第5期40-44,共5页Electronic Journal of Medical Operations

摘　　要：目的观察不同体位下有限切开使用股骨近端防旋髓内钉(Proximal Femoral Nail Antirotation,PFNA)内固定治疗股骨粗隆间骨折的临床疗效。方法回顾性分析自2016年1月—2021年1月,对于难复性股骨粗隆间骨折采用有限切开方式复位的116例患者。根据体位不同将所有患者分为研究组和对照组,各58例,研究组采用侧卧位有限切开使用PFNA内固定治疗,对照组采用仰卧位有限切开使用PFNA内固定治疗。统计分析所有患者的整体疗效,并对比分析两组患者的手术时间、术中出血量、骨折愈合时间、髋关节功能评分量表评分(Harris Hip Joint Function Scale,Harris)、并发症情况。结果116例患者均获随访,时间6~24个月,平均18个月。术后髋关节正侧位X线片复查显示骨折复位满意。其中对照组有3例术后出现髋部疼痛,复查X线片显示螺旋刀片松动,经卧床休养及药物治疗后延迟愈合。113例骨折均一期愈合。末次随访时按髋关节功能Harris评分:研究组优50例,良8例,对照组优39例,良19例,研究组Harris评分明显优于对照组(x2=5.841,P=0.016)。研究组手术时间、术中出血量显著低于对照组(P<0.05),且两组愈合时间、Harris评分、并发症发生率比较无统计学差异(P>0.05)。结论侧卧位有限切开治疗股骨粗隆骨折具有复位可靠、便于操作,不需要手术牵引床,允许早期髋关节康复锻炼的优点。Objective To observe the clinical efficacy of proximal femoral nail antirotation(PFNA)in the treatment of intertrochanteric fractures with limited incision in different body positions.Methods From January 2016 to January 2021,116 patients with irreducible intertrochanteric fracture treated by limited open reduction were retrospectively analyzed.All patients were divided into study group and control group according to different body positions,58 cases in each group.The study group was treated with lateral decubitus limited incision and PFNA internal fixation,while the control group was treated with supine limited incision and PFNA internal fixation.The overall efficacy of all patients was statistically analyzed,and the operation time,intraoperative blood loss,fracture healing time,Harris Hip Joint Function Scale(Harris)score and complications were compared between the two groups.Results All 116 cases were followed up 6~24 months(mean,18 months).Standard anteroposterior and lateral radiographs of the hip joint showed satisfactory reduction and fixation.In the control group,3 patients had hip pain after operation,and the reexamination of X-ray film showed that the spiral blade was loose,and the fracture union was delayed after bed rest,delayed weight bearing and anti-osteoporosis drug treatment.The rest 113 cases were all primary healing.At the last follow-up,the Harris score of hip joint function was evaluated as excellent in 50 cases and good in 8 cases in the study group,and excellent in 39 cases and good in 19 cases in the control group.The Harris score of the study group was significantly better than that of the control group(x2=5.841,P=0.016).The operation time and intraoperative blood loss in the study group were significantly less than those in the control group(P<0.05),and there were no significant differences in fracture healing time,Harris score and complication rate between the two groups(P>0.05).Conclusion Lateral decubitus limited incision for the treatment of femoral trochanteric fracture has the adva

关 键 词：股骨粗隆骨折 股骨近端防旋髓内钉 PFNA 有限切开 

分 类 号：R687.3[医药卫生—骨科学]