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[1]陸洲,孫奇,裘曉冬,等.無牽引床仰臥位不擴(kuò)髓與擴(kuò)髓股骨近端防旋髓內(nèi)釘內(nèi)固定治療老年股骨轉(zhuǎn)子間骨折的比較研究[J].中醫(yī)正骨,2017,29(09):15-18，27.
　LU Zhou,SUN Qi,QIU Xiaodong,et al.A comparative study of unreamed versus reamed proximal femoral nail antirotation internal fixation in the supine position without traction table for treatment of intertrochanteric fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(09):15-18，27.
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無牽引床仰臥位不擴(kuò)髓與擴(kuò)髓股骨近端防旋髓內(nèi)釘內(nèi)固定治療老年股骨轉(zhuǎn)子間骨折的比較研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期數(shù):
2017年09期
頁碼:
15-18，27
欄目:
臨床研究
出版日期:
2017-09-20

文章信息/Info

Title:
A comparative study of unreamed versus reamed proximal femoral nail antirotation internal fixation in the supine position without traction table for treatment of intertrochanteric fractures in the aged
作者:
陸洲; 孫奇; 裘曉冬; 駱志航; 任雅春
浙江省杭州市富陽中醫(yī)骨傷醫(yī)院,浙江 杭州 311400
Author(s):
LU Zhou; SUN Qi; QIU Xiaodong; LUO Zhihang; REN Yachun
Fuyang TCM Orthopedic-Traumatological Hospital,Hangzhou 311400,Zhejiang,China
關(guān)鍵詞:
髖骨折;  轉(zhuǎn)子間骨折;  骨折固定術(shù); 髓內(nèi);  老年人
Keywords:
Key words hip fractures;  intertrochanteric fractures;  fracture fixation; intramedullary;  aged
摘要:
目的:比較無牽引床仰臥位不擴(kuò)髓與擴(kuò)髓股骨近端防旋髓內(nèi)釘(proximal femoral nail antirotation,PFNA)內(nèi)固定治療老年股骨轉(zhuǎn)子間骨折的臨床療效。方法:回顧性分析120例老年股骨轉(zhuǎn)子間骨折患者的病例資料,其中采用無牽引床仰臥位不擴(kuò)髓PFNA內(nèi)固定60例,無牽引床仰臥位擴(kuò)髓PFNA內(nèi)固定60例。男51例,女69例。年齡75～93歲,中位數(shù)83歲。按照股骨轉(zhuǎn)子間骨折的AO分型,穩(wěn)定型(A1型和A2.1型)20例、不穩(wěn)定型(A2.2型、A2.3型和A3型)100例。合并1種內(nèi)科疾病17例、2種內(nèi)科疾病74例、2種以上內(nèi)科疾病29例。受傷至手術(shù)時(shí)間1～7 d,中位數(shù)4 d。比較2組患者手術(shù)時(shí)間、術(shù)中失血量及隱性失血量,并于術(shù)后3個(gè)月比較2組患者Harris髖關(guān)節(jié)評(píng)分。結(jié)果:不擴(kuò)髓組術(shù)中失血量和隱性失血量均小于擴(kuò)髓組[(105.40±26.40)mL,(156.30±38.50)mL,t=8.580,P=0.000;(280.60±98.20)mL,(320.50±115.30)mL,t=2.051,P=0.043],手術(shù)時(shí)間短于擴(kuò)髓組[(76.40±13.10)min,(85.30±16.20)min,t=3.382,P=0.001]; 術(shù)后3個(gè)月,2組患者Harris髖關(guān)節(jié)評(píng)分比較,差異無統(tǒng)計(jì)學(xué)意義[(83.80±14.70)分,(85.60±15.30)分,t=0.657,P=0.512]。結(jié)論:對(duì)于老年股骨轉(zhuǎn)子間骨折患者而言,在髖關(guān)節(jié)功能恢復(fù)方面,無牽引床仰臥位不擴(kuò)髓PFNA內(nèi)固定與擴(kuò)髓PFNA內(nèi)固定無明顯差異,但不擴(kuò)髓PFNA內(nèi)固定較擴(kuò)髓PFNA內(nèi)固定的手術(shù)時(shí)間短、失血量少,符合老年患者的治療要求,可作為臨床治療老年股骨轉(zhuǎn)子間骨折的一種較為理想的選擇。
Abstract:
ABSTRACT Objective:To compare the clinical curative effect of unreamed versus reamed proximal femoral nail antirotation(PFNA)internal fixation in the supine position without traction table in the treatment of intertrochanteric fractures in the aged.Methods:The medical records of 120 aged patients with intertrochanteric fractures were analyzed retrospectively.Sixty patients were treated with unreamed PFNA internal fixation in the supine position without traction table(group A),while the others were treated with reamed PFNA internal fixation in the supine position without traction table(group B).The patients consisted of 51 males and 69 females,and ranged in age from 75 to 93 years(Median=83 yrs).According to AO classification of intertrochanteric fractures,the fractures belonged to stable-type(A1 and A2.1)in 20 cases and unstable-type(A2.2,A2.3 and A3)in 100 cases.Seventeen patients had one kind of morbus internus,and 74 patients had two kinds of morbus internus,and 29 patients had more than 2 kinds of morbus internus.The patients ranged in disease course from 1 to 7 days(Median=4 days).The operative time,intraoperative blood loss and hidden blood loss were compared between the 2 groups,and the Harris hip scores were compared between the 2 groups at 3 months after the surgery.Results:The intraoperative blood loss and hidden blood loss were less and the operative time was shorter in group A compared to group B(105.40+/-26.40 vs 156.30+/-38.50 ml,t=8.580,P=0.000; 280.60+/-98.20 vs 320.50+/-115.30 ml,t=2.051,P=0.043; 76.40+/-13.10 vs 85.30+/-16.20 min,t=3.382,P=0.001).There was no statistical difference in the Harris hip scores between the 2 groups at 3 months after the surgery(83.80+/-14.70 vs 85.60+/-15.30 points,t=0.657,P=0.512).Conclusion:For aged patients with intertrochanteric fractures,there are no significant difference in hip joint functional recovery between unreamed and reamed PFNA internal fixation.However,unreamed PFNA internal fixation has the advantages of shorter operative time and less blood loss compared to reamed PFNA internal fixation,therefore,it can meet the requirement for treatment of aged patients and can be used as an ideal therapy for treatment of intertrochanteric fractures in the aged.

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更新日期/Last Update: 2018-02-23