摘要
目的比较侧卧位与仰卧位股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)内固定治疗单侧股骨转子下骨折的疗效。方法回顾性分析2018年2月—2021年2月南京市中医院骨伤科收治的126例行PFNA内固定治疗的单侧股骨转子下骨折患者的临床资料。男性85例,女性41例;年龄26~63岁,平均42.1岁;致伤机制:跌倒伤42例,道路交通伤58例,高处坠落伤26例;Seinsheimer分型:ⅢA型39例,ⅢB型52例,Ⅳ型35例。根据术中体位分为仰卧位组(60例)和侧卧位组(66例)。比较两组围术期相关指标、术后髋关节功能、髋关节活动度和疼痛程度变化,以及术后并发症差异。结果侧卧位组手术时间[(68.1±10.4)min vs.(75.3±13.6)min]、术后住院时间[(6.4±2.1)d vs.(8.3±2.2)d]短于仰卧位组(P<0.05),术中出血量[(222.4±56.3)mL vs.(246.2±65.2)mL]、术中透视次数[(18.3±4.0)次vs.(21.1±5.3)次]少于仰卧位组(P<0.05)。两组术后1、2、3、6、12个月髋关节Harris评分、改良Merle D’Aubigne-Postel评分、髋关节活动度均较术前(T_(0))逐渐增高(P<0.05),视觉模拟评分(visual analogue scale,VAS)则逐渐降低(P<0.05),但两组间术后1、2、3、6、12个月Harris评分、改良Merle D’Aubigne-Postel评分、髋关节活动度、VAS比较差异均无统计学意义(P>0.05)。两组并发症发生率(5.00%vs.3.03%)比较,差异无统计学意义(P>0.05)。结论仰卧位和侧卧位均有利于PFNA内固定术后单侧股骨转子下骨折患者康复,与仰卧位比较,侧卧位可缩短手术时间和住院时间,减少术中出血和透视次数,更适合单侧股骨转子下骨折患者的手术治疗。
Objective To investigate the effect of lateral and supine proximal femoral nail antirotation(PFNA)internal fixation in lateral and supine positions for the treatment of unilateral subtrochanteric fractures of the femur.Methods Clinical data of 126 patients with unilateral subtrochanteric femoral fractures after PFNA internal fixation in the department of orthopedics and traumatology of Nanjing Hospital of Traditional Chinese Medicine from Feb.2018 to Feb.2021 were analyzed retrospectively.There were 85 males and 41 females with an average age of 42.1 years(range,26-63 years).The mechanism of injuries included falls in 42 cases,road traffic crashes in 58 cases,and falls from height in 26 cases.Based on Seinsheimer classification,there were 39 cases of typeⅢA,52 typeⅢB and 35 typeⅣ.The patients were divided into supine position group(60 cases)and lateral position group(66 cases)according to the intraoperative posture.The perioperative indexes,postoperative hip function,hip range of motion and pain,and postoperative complications were collected and compared between the two groups.Results Compared with the supine position group,the lateral position group had a much shorter operative time(min,68.1±10.4 vs.75.3±13.6)and postoperative length of hospital stay(d,6.4±2.1 vs.8.3±2.2)(both P<0.05),as well as much less intraoperative blood loss(mL,222.4±56.3 vs.246.2±65.2)and intraoperative fluoroscopy frequency times(18.3±4.0 vs.21.1±5.3)(both P<0.05).For all the patients,the Harris hip score,modified Merle D’Aubigne Postel score,and hip range of motion at postoperative 1,2,3,6 and 12 months showed a gradually increase trend,and visual analogue scale(VAS)a gradual decrease trend.All the above-mentioned parameters was much higher or lower than those before surgery at all time point(all P<0.05),but none of them showed significant difference between any time point postoperatively(all P>0.05).Conclusion Both supine position and lateral position are conducive to the rehabilitation of patients with unilateral subtrochanteric femoral fractures after PFNA internal fixation.Compared with supine position,lateral position can shorten the operation time and hospital stay,and decrease intraoperative bleeding and needs for fluoroscopy,and thus more suitable for surgical treatment of such fractures.
作者
童凯
尹宏
谢杨
Tong Kai;Yin Hong;Xie Yang(Department of Orthopedics and Traumatology,Nanjing Hospital of Traditional Chinese Medicine,Nanjing 210001,China;Department of Orthopaedics,Shanghai Changhai Hospital,Shanghai 200433,China)
出处
《创伤外科杂志》
2022年第12期924-930,共7页
Journal of Traumatic Surgery
基金
江苏省自然科学基金青年科技人才专项(BK20162063)。
关键词
股骨转子下骨折
髓内钉
骨折固定
体位
Unilateral subtrochanteric femoral fractures
Intramedullary nail
Fracture fixation
Position
