【摘要】 目的探讨股骨近端防旋髓内钉(PFNA)内固定治疗股骨粗隆间骨折术中应用骨科牵引床的优缺点。方法回顾性分析自2010-12—2014-02采用PFNA内固定治疗的165例股骨粗隆间骨折,根据手术时是否应用牵引床分为牵引床组和非牵引床组。记录并比较2组手术时间、PFNA尾帽安装时间、术中失血量、尖顶距(TAD)值、术后并发症、骨折愈合时间以及末次随访时髋关节Harris评分。结果所有患者均获得9~24(15.5±6.5)个月随访,骨折均顺利愈合。牵引床组手术时间(41.7±9.1)min,术中失血量(115.5±16.4)ml;非牵引床组手术时间(45.5±9.5)min,术中失血量(131.6±18.7)ml,牵引床组手术时间、术中出血量均少于非牵引床组,差异有统计学意义(t=0.751,P=0.010;t=0.008,P<0.001)。牵引床组手术时尾帽安装时间为327.0(214.3,523.8)s,非牵引床组为277.0(93.0,389.0)s,牵引床组尾帽安装时间较与非牵引床组多,差异有统计学意义(t=-2.726,P=0.006)。牵引组并发症发生率高于非牵引组,差异有统计学意义(χ2=9.354,P=0.002)。2组TAD值、骨折愈合时间及末次随访时髋关节功能Harris评分比较差异无统计学意义(P>0.05)。结论应用牵引床具有可长时间保持骨折端的复位状态、节省人力、减少术者放射性损伤、减少术中出血及手术时间的优点,但也存在尾帽安装困难、术后并发症多、增加侧位透视难度等缺点。更多还原

【Abstract】 Objective To explore the advantages and disadvantages of application of orthopedic traction bed in treatment of intertrochanteric fractures with proximal femoral nail antirotation(PFNA). Methods A retrospective study was performed of165 patients with intertrochanteric fractures who were treated with proximal femoral nail antirotation from December 2010 to February 2014. They were assigned into 2 groups according to application of traction bed or general surgery bed in operation.The time of operation, installation time of nut at the end of the PFNA, blood loss, tip-apex distance(TAD), complications, time of fracture healing and Harris hip score at the last follow-up were recorded and compared. Results All patients got 9-24 months of follow-up(average, 15.5±6.5). All fractures were healed smoothly. The operation time of patients with traction bed was(41.7±9.1)min, intraoperative blood loss was(115.5 ±16.4)ml, and the operation time of patients with general surgery bed was(45.5±9.5)min, intraoperative blood loss was(131.6±18.7)ml, the operation time and intraoperative blood loss of traction bed group were less than that of general surgery bed group, there was a significant difference( t =0.751, P =0.010; t =0.008, P<0.001). The installation time of nut at the end of the group with traction bed was 327.0(214.3, 523.8)s, more than the time of general surgery bed group which was 277.0(93.0, 389.0)s, there was a significant difference( t =-2.726, P =0.006). Between two groups the difference in incidence of complications was significant(χ2=9.354, P =0.002). There was no significant difference in TAD, fracture healing time and the Harris hip score at the time of the last follow-up of 2 groups( P >0.05). Conclusion The traction bed has the advantages in keeping the fracture of the reset state for long time, save manpower, reducing radiation damage, decreasing intraoperative bleeding and the operation time, but there are still shortcomings like difficulty to install nut,much complications and increase the difficulty of oblique perspective.更多还原