不同体位内固定与股骨转子间骨折并发症的关系  

The Relationship Between Internal Fixation in Different Positions and Complications of Intertrochanteric Fractures of Femur

作　　者：张永祥 吴启弘 余江 潘杰 何立民 ZHANG Yongxiang;WU Qihong;YU Jiang;PAN Jie;HE Limin(Department of orthopedics,The second affiliated hospital of Guizhou university of TCM,Guiyang,Guizhou 550000)

机构地区：[1]贵州中医药大学第二附属医院骨科,贵州贵阳550000

出　　处：《中国伤残医学》2024年第9期44-48,52,共6页Chinese Journal of Trauma and Disability Medicine

摘　　要：目的:研究不同体位下手法闭合复位与切开复位股骨近端防旋髓内钉(PFNA)内固定治疗老年股骨转子间骨折对其并发症的影响。方法:回顾性收集2020年11月-2022年12月我院收治的66例股骨转子间骨折患者资料作为研究对象,按不同体位分为侧卧组和平卧组。侧卧组(n=35)患者采用侧卧位PFNA内固定,平卧组(n=31)患者采用平卧位PFNA内固定。比较2组患者的手术时间、出血量、开始负重时间、住院天数等围手术期指标,同时比较2组患者的肺部感染、下肢血栓、心功能障碍、压疮等并发症情况。结果:侧卧组术中出血量少于平卧组,手术时间、开始负重时间、住院天数多于平卧组,髋关节恢复评分高于平卧组,组间差异有统计学意义(P<0.05);2组骨折愈合时间比较,差异无统计学意义(P>0.05);侧卧组肺部感染、下肢血栓、心功能障碍、压疮、固定松动发生率低于平卧组,组间差异有统计学意义(P<0.05);2组再次骨折、髋内翻比较,差异无统计学意义(P>0.05);组别(不同体位)、Evans分型、手术时间、髋关节恢复评分是并发症的影响因素。结论:不同体位下应用PFNA内固定治疗老年股骨转子间骨折均有效,其中侧卧位要优于平卧位,且并发症较少。同时,并发症事件发生次数与不同体位、Evans分型、手术时间、髋关节恢复评分相关,临床要加以重视。Objective:To study the effects of manual closed reduction and open reduction with proximal femoral nail antirotation(PFNA)internal fixation in the treatment of elderly intertrochanteric fractures in different positions on their complications.Methods:Retrospective collection of data from 66 patients with intertrochanteric fractures of the femur admitted to our hospital from November 2020 to December 2022 as research subjects,divided into lateral group and supine group according to different body positions.Patients in the lateral lying group(n=35)were treated with PFNA internal fixation in the lateral lying position,while patients in the supine group(n=31)were treated with PFNA internal fixation in the supine position.The perioperative indicators such as surgical time,bleeding volume,start of weight-bearing,and length of hospital stay between two groups of patients were compared,as well as the incidence of complications such as pulmonary infection,lower limb thrombosis,cardiac dysfunction,and pressure ulcers between the two groups of patients were compared.Results:The side lying group had less intraoperative bleeding than the supine group,and had more surgery time,start of weight-bearing time,and length of hospital stay than the supine group.The hip joint recovery score was higher than that of the supine group,the differences between groups were statistically significant(P<0.05);Comparison of healing time between two groups of fractures,the differences was not statistically significant(P>0.05).The incidence of pulmonary infection,lower limb thrombosis,cardiac dysfunction,pressure ulcers,and loosening of fixation in the lateral lying group is lower than that in the supine group,the differences between groups were statistically significant(P<0.05).Comparison of two groups of recurrent fractures and hip varus,the differences was not statistically significant(P>0.05).Factors affecting complications include group(different body positions),Evans classification,surgical time,and hip joint recovery score.Conclusion:The app

关 键 词：手法闭合复位 切开复位 PFNA内固定 老年股骨转子间骨折 

分 类 号：R687.3[医药卫生—骨科学]