摘要【目的】探讨经骨皮质临时固定技术在股骨转子间骨折行股骨近端防旋髓内钉内固定(proximal femoral nail antirotation,PFNA)术中维持复位的临床效果。【方法】选取2017年1月至2019年1月于城固县中医医院行闭合复位PFNA治疗的80例股骨转子间骨折患者为研究对象,根据随机数字表法分为对照组和观察组。对照组术中采取常规PFNA手术治疗,观察组PNFA术中采取经骨皮质临时固定技术治疗。观察两组患者手术时间、术中出血量、输血量、术中透视次数、术中复位质量以及术后负重时间并比较两组骨折愈合时间及并发症发生情况。采用Harris评分对两组患者术后1年髋关节功能恢复情况进行评估。【结果】两组患者均顺利完成手术。两组患者手术时间、术中出血量、输血量以及负重时间比较差异均无显著性(P>0.05);观察组透视次数少于对照组,且术中复位质量优于对照组(P<0.05)。术后两组均获得1～16个月的随访,无失访者,平均随访时间(13.67±1.68)个月,两组患者在随访期间无相关并发症发生,且两组患者骨折愈合时间比较差异均无显著性(P>0.05)。观察组术后1年Harris评分明显高于对照组(P<0.05)。【结论】闭合复位PNFA术中使用经骨皮质临时固定技术可明显维持股骨转子间骨折PFNA术中复位效果,提高复位质量,且不增加手术时间和术中出血量,有利于患者术后髋关节功能恢复。
Abstract：【Objective】To investigate the clinical effect of maintaining reduction by transcortical temporary fixation in the treatment of femoral intertrochanteric fracture with PFNA(proximal femoral nail antirotation). 【Methods】From January 2017 to January 2019, 80 cases of intertrochanteric fracture of femur treated with closed reduction and proximal femoral anti rotation intramedullary nailing(PNFA) were selected as the study objects. According to the order of admission, the patients were divided into the control group and the observation group. The control group received routine treatment during the PFNA surgery and the observation group received transcortical temporary fixation during PFNA surgery. The operation time, intraoperative hemorrhage, blood transfusion, intraoperative fluoroscopy times, intraoperative reduction quality and postoperative weight-bearing time of the two groups were observed. The complications and fracture healing time were compared during the follow-up. Harris score was used to evaluate the recovery of hip joint function of the two groups one year after operation. 【Results】Both groups of patients were successfully completed the operation. There was no significant difference in operation time, blood loss, blood transfusion and weight-bearing time between the two groups(P>0.05).The times of fluoroscopy in the observation group was less than that in the control group, and the quality of reduction during operation was better than that in the control group(P< 0.05).After operation, the patients in both groups were followed up for 1-16 months, with no lost patients. The average follow-up time was(13.67±1.68) months. During the follow-up period, there were no related complications in the two groups, and there was no difference in fracture healing time between the two groups(P>0.05).The Harris score of the observation group was significantly higher than that of the control group at 1 year after operation(P< 0.05). 【Conclusion】The use of transcortical temporary fixation technique in closed reduction of PNFA can significantly maintain the reduction effect of intertrochanteric fracture of femur, improve the reduction quality, and do not increase the operation time and the amount of intraoperative bleeding, which is conducive to the recovery of hip joint function.
2021, Vol. 38 
