不同体位下防旋股骨近端髓内钉治疗老年骨质疏松性股骨粗隆间及股骨粗隆下骨折的效果观察

目的 探讨分析不同体位下防旋股骨近端髓内钉（PFNA）治疗老年骨质疏松性股骨粗隆间及股骨粗隆下骨折的效果.方法 选择2009年1月～2012年12月收治的老年骨质疏松性股骨粗隆间及股骨粗隆下骨折患者80例为研究对象,根据PFNA治疗时牵引方式分为A组（侧卧位徒手牵引）和B组（仰卧位牵引床牵引）,每组各40例.比较两组患者手术时间、术中出血量、手术切口长度、骨折愈合时间、并发症及术后1年的Harris髋关节评分.结果 A组患者手术时间、术中出血量及手术切口长度都显著优于B组患者,两组患者比较差异有高度统计学意义（P＜0.01）.而两组患者的骨折愈合时间相比,差异无统计学意义（P＞0.05）;两组患者的术后1年Harris髋关节评分差异无统计学意义（P＞0.05）.结论 侧卧位下行PFNA内固定手术治疗老年骨质疏松性股骨粗隆间及股骨粗隆下骨折可以有效减轻手术对患者身心的损伤,取得了良好的治疗效果.

Effect observation of proximal femoral nail antirotation in different positions in the treatment of osteoporotic femoral intertrochanteric and subtrochanteric fracture in the elderly

Objective To discuss and analyze the effects of proximal femoral nail antirotation （PFNA） in different positions in the treatment of osteoporotic femoral intertrochanteric and subtrochanteric fracture in the elderly.Methods 80 elderly patients with osteoporotic femoral intertrochanteric and subtrochanteric fracture admitted from January 2009 to December 2012 were selected as study objects,they were respectively divided into group A （pulled by hand in lateral position） and group B （pulled by traction table in supine position） according to the traction methods for PFNA treatment,with 40 cases in each group.The operation time,intraoperative amount of bleeding,incision length,healing time of fracture,complication,and Harris hip joint scores of two groups were compared.Results The operation time,intraoperative amount of bleeding,and incision length in the group A were all superior to those in the group B,the differences of two were highly statistically significant （P 〈 0.01）.There was no statistically significant difference in healing time of fractures of two groups （P 〉 0.05）.One year after surgery,the Harris hip joint scores in the two groups had no statistically significant difference （P 〉 0.05）.Conclusion In the treatment of osteoporotic femoral intertrochanteric and subtrochanteric fracture in the elderly,internal fixation of PFNA downwards in lateral position can effectively alleviate patient＇s physical and mental damage,and obtain a good therapeutic effect.