不同体位的PFNA内固定术治疗老年股骨粗隆间骨折患者对围手术期指标、骨折愈合及并发症的影响

Effect of PFNA internal fixation in different positions on perioperative indicators,fracture healing,and complications in elderly patients with intertrochanteric fractures of the femur

中文关键词: 股骨近端髓内钉内固定术    老年    股骨粗隆间骨折    不同体位    骨折愈合

英文关键词: intramedullary nail fixation of proximal femur  old age  intertrochanteric fracture of femur  different positions  fracture healing

中文摘要:

      目的 探讨牵引床平卧位和无牵引床侧卧位股骨近端髓内钉(PFNA)内固定术对老年股骨粗隆间骨折患者围手术期指标、骨愈合情况及术后并发症的影响。方法 选择2021年7月至2024年2月于哈尔滨医科大学附属第四医院骨科就诊的100例老年股骨粗隆间骨折患者，采用随机数字表法均分为对照组(50例，实施牵引床平卧位PFNA内固定术)和观察组(50例，实施非牵引床侧卧位PFNA内固定术)。比较2组围手术期临床指标及骨折复位质量等。结果 与对照组比较，观察组手术时长、切口长度较短，术中出血量较少(均P<0.001)。术后1个月观察组骨折端前后位重叠率高于对照组，股骨转子间骨折侧位成角小于对照组(均P<0.05)。而术后1个月2组骨折端侧位重叠率、颈干角和术后1、3、6个月髋关节功能评分，以及骨折愈合时间和并发症发生率比较差异均无统计学意义(均P>0.05)。结论 使用牵引床平卧位和无牵引床侧卧位进行PFNA内固定术治疗老年股骨粗隆间骨折在疗效上未观察到显著差异，而无牵引床侧卧位方法在手术时间、切口大小及术中出血量等方面表现出优势。

英文摘要:

      Objective To explore the effects of proximal femoralnail antirotation(PFNA)internal fixation in the supine position of the traction bed and the lateral position without traction on perioperative indicators,bone healing and postoperative complications in elderly patients with intertrochanteric fractures of the femur.Methods One hundred elderly patients with intertrochanteric fractures of the femur who visited the Department of Orthopedics of the Fourth Affiliated Hospital of Harbin Medical University from July 2021 to February 2024 were selected and equally divided into the control group of 50 cases who underwent traction bed supine position surgery and the observation group of 50 cases who underwent non-traction lateral position PFNA internal fixation by random number table method.The perioperative clinical indicators and fracture reduction quality,etc.of the two groups were compared.Results Compared with the control group,the operation duration and incision length of the observation group were shortened,and the amount of blood loss during the operation was decreased(P<0.05).One month after operation,the overlap rate of fracture end in observation group was higher than that in control group,and the lateral angulation of femoral intertrochanteric fracture was lower than that in control group(P<0.05).There were no significant differences between the two groups in fracture end and lateral overlap rate,cervical trunk angle,hip function score,fracture healing time and complication rate at 1 month,3 months and 6 months after surgery(all P>0.05).Conclusion There was no significant difference observed in the efficacy of PFNA internal fixation surgery for elderly intertrochanteric fractures using traction frame supine position and lateral position without traction frame.The method of lateral positioning without traction frame has shown significant advantages in terms of surgical time,incision size,and intraoperative blood loss,and has the value of promotion and application.