两种体位方法置入PFNA治疗31-A2型股骨转子间骨折伴骨质疏松患者的近期并发症与远期随访分析

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摘要目的探讨两种体位方法置入股骨近端防旋髓内钉（PFNA）治疗31-A2型股骨转子间骨折伴骨质疏松患者近期并发症与远期随访情况。方法选取2014年12月—2019年5月安徽省六安市中医院骨伤四科收治的31-A2型股骨转子间骨折伴骨质疏松患者92例进行研究，将其按随机数字表法分为试验组和对照组，每组46例。试验组取健侧卧位下置入PFNA，对照组取仰卧位下置入PFNA。比较两组一般资料、手术情况、近期并发症发生率、住院时间、髋关节功能和远期随访情况。结果两组手术时间比较，差异无统计学意义（P ＞ 0.05）；试验组术中出血量、术后引流量和近期并发症总发生率少于对照组，住院时间短于对照组，差异均有统计学意义（均P ＜ 0.05）。随访中，试验组46例中有3例病例脱落，剩43例，对照组46例中有4例病例脱落，剩余42例。两组术后各时间点Harris功能评分高于术前，差异均有统计学意义（均P ＜ 0.05）；术前和术后12个月两组Harris功能评分比较，差异无统计学意义（P ＞ 0.05）；试验组术后1、6个月Harris功能评分高于对照组，差异均有统计学意义（均P ＜ 0.05）。试验组术后下地负重时间、骨折愈合时间短于对照组，内固定周围骨折发生率低于对照组，差异均有统计学意义（均P ＜ 0.05）；两组手术失败发生率和二次手术发生率比较，差异无统计学意义（P ＞ 0.05）。结论采取健侧卧位下置入PFNA治疗31-A2型股骨转子间骨折伴骨质疏松可减少患者住院时间和近期并发症发生率，可更早的恢复髋关节功能，缩短了下地负重时间和骨折愈合时间。

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	刘杨1 张弢1 熊绪成1 陈义权1 赵阳1 邵松2▲

关键词 ： 31-A2型股骨转子间骨折, 骨质疏松, 股骨近端防旋髓内钉, 髋关节功能

Abstract：

Objective To investigate the proximal femoral nail anti-rotation (PFNA) for treatment of type 31-A2 intertrochanteric fractures patients with osteoporosis by two postural approaches. Methods A total of 92 patients with type 31-A2 intertrochanteric fracture and osteoporosis admitted to the Fouth Department of Orthopedics and Traumatology, Lu′an Hospital of Traditional Chinese Medicine from December 2014 to May 2019 were selected for study, and they were divided into the experimental group and the control group according to the random number table method, with 46 patients in each group. In the experimental group, PFNA was placed in the healthy lateral position, while in the control group, PFNA was placed in the supine position. The two groups were compared for general information, surgical conditions, incidence of recent complications, length of hospital stay, hip function, and long-term follow-up. Results There was no significant difference in operation time between the two groups (P ＞ 0.05). The experimental group had less intraoperative blood loss, postoperative drainage volume and total incidence of recent complications, and shorter the length of hospital stay than the control group, with statistically significant differences (all P ＜ 0.05). During follow-up, three of the 46 cases in the experimental group fell off, leaving 43 cases, and four of the 46 cases in the control group fell off, leaving 42 cases. Harris function score was higher in the two groups at each time point after surgery than before surgery, and the differences were statistically significant (all P ＜ 0.05). There was no significant difference in Harris function scores between the two groups before and 12 months after surgery (P ＞ 0.05). Harris function scores one and six months after surgery in the experimental group were higher than those in the control group, with statistically significant differences (all P ＜ 0.05). The weight bearing time and fracture healing time of the experimental group were shorter than those of the control group, and the incidence of fractures around internal fixation was lower than that of the control group, with statistically significant differences (all P ＜ 0.05). There was no significant difference in the incidence of surgical failure and secondary surgery between the two groups (P ＞ 0.05). Conclusion PFNA placement in lateral lying uninjured position for treatment of type 31-A2 intertrochanteric fracture with osteoporosis can reduce the length of hospital stay and the incidence of recent complications, restore hip function earlier, and shorten the time of underground loading and fracture healing.

Key words： Type 31-A2 intertrochanteric fracture Osteoporosis Proximal femoral nail anti-rotation Hip joint function

基金资助:安徽医科大学校科研基金项目（2019xkj222）。

通讯作者: ▲通讯作者

引用本文:

刘杨1 张弢1 熊绪成1 陈义权1 赵阳1 邵松2▲. 两种体位方法置入PFNA治疗31-A2型股骨转子间骨折伴骨质疏松患者的近期并发症与远期随访分析[J]. 中国医药导报, 2020, 17(24): 93-97.
LIU Yang1 ZHANG Chen1 XIONG Xucheng1 CHEN Yiquan1 ZHAO Yang1 SHAO Song2▲. Analysis of the recent complications and long-term follow-up of type 31-A2 intertrochanteric fracture patients with osteoporosis treated by PFNA implantation by two postural methods. 中国医药导报, 2020, 17(24): 93-97.

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