【摘要】 目的:探讨平卧体位无牵引床下闭合复位股骨近端防旋髓内钉(proximal femoral nail anti rotation,PFNA内固定治疗股骨转子间骨折的疗效,分析其可行性。方法:回顾分析2014年6月至2018年3月间治疗并获得随访的45例股骨转子间骨折患者资料,男21例,女24例;年龄43～92岁,平均67.4岁;左侧18例,右侧27例;骨折按Evans-Jensen分型,Ⅱ型7例,Ⅲ型17例,Ⅳ型16例,Ⅴ型5例;受伤至手术时间2～6 d。记录患者手术时间、出血量、骨折愈合时间、术后并发症发生情况及髋关节Harris评分等。结果:45例患者手术时间35～80 min,平均52.6 min;术中出血量40～110 ml,平均68.7 ml;住院时间6～11 d,平均8.4 d;随访时间12～18个月,平均14.7个月。2例患者内固定失败,43例患者获得骨性愈合;围手术期下肢深静脉血栓形成1例,行下腔静脉滤器置入;2例术后随访内固定切出,行翻修髋关节置换术;1例切口浅表感染,经抗炎、换药治疗痊愈;并发症发生率8.9%(4/45)。末次随访髋关节Harris评分56～95(81.30±8.40)分,其中优15例,良26例,可2例,差2例。结论:平卧体位,无牵引床下进行闭合复位防旋髓内钉内固定术治疗股骨转子间骨折安全可行,具有创伤小、并发症低等优点,临床疗效满意,值得基层医院推广使用。更多还原

【Abstract】 Objective:To investigate the effect and feasibility of closed reduction and internal fixation with PFNA in the treatment of intertrochanteric fracture of femur in the supine position without traction bed. Methods:From June 2014 to March2018,45 patients with intertrochanteric fracture of femur who were treated and followed up were analyzed retrospectively.There were 21 males and 24 females,with an average age of 67.4 years(43 to 92 years);18 cases on the left side and 27 on the right side. According to Evans Jensen classification,there were 7 patients of type Ⅱ,17 patients of type Ⅲ,16 patients of type Ⅳ and 5 patients of type Ⅴ. The time from injury to operation was 2 to 6 days. The operation time,blood loss and fracture healing,closing time,postoperative complications and Harris score of hip joint were recorded. Results:The operation time of 45 patients was 35 to 80 min,with an average of 52.6 min;the intraoperative bleeding volume was 40 to 110 ml,with an average of68.7 ml;the hospitalization time was 6 to 11 days,with an average of 8.4 days;the follow up time was 12 to 18 months,with an average of 14.7 months;the internal fixation of 2 patients failed,and 43 patients achieved bony healing;the deep vein thrombosis of the lower extremity in the perioperative period was 1 case,and the inferior vena cava filter was inserted;the internal fixation of 2 patients was cut out,and the hip was renovated. The incidence of complications was 8.9%(4/45). At the final follow up,Harris score of hip joint was 56 to 95(81.30±8.40),including excellent 15 cases,good 26 cases,fair 2 cases and poor 2 cases. Conclusion:It is safe and feasible to treat intertrochanteric fracture of femur with closed reduction and anti rotation intramedullary nailing under the bed without traction in a supine position. It has the advantages of small trauma and low complications,and the clinical effect is satisfactory. It is worth popularizing and using in basic hospitals.更多还原