经皮外固定架和PFNA治疗老年高危股骨粗隆间骨折的临床效果

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Abstract Objective To investigate and compare the clinical curative effect between the external fixation and the proximal femoral nail antirotation (PFNA) in high-risk elderly patients with intertrochanteric fracture. Methods Sixty elderly patients with high-risk of intertrochanteric fracture in Department of Orthopaedics and Traumatology, Hebei Provincial Hospital of Traditional Chinese Medicine from January 2015 to January 2017 were selected. Patients were divided in two groups regarding to treatment. In group A (n=30), all patients were treated with external fixator under local anesthesia, while in group B (n=30) were treated with PFNA under subarachnoid anesthesia or general anesthesia. The changes of Hb and ALB before and after operation were recorded, meanwhile the operation time, the amount of intraoperative bleeding, the number of intraoperative fluoroscopy, the bed time after operation, and the Harris hip joint score at 6 months after operation were recorded. Results All patients received satisfactory reduction during operation, the fixator was well accepted and no patient had significant difficulties while sitting or lying. The decrease of Hb and ALB after operation were lower in group A than that in group B, and the difference between the two groups was statistically significant (P < 0.05). The operation time, the amount of intraoperative bleeding, the number of intraoperative fluoroscopy and the days of hospitalization were lesser in group A than those in the group B, and the difference between the two groups was statistically significant (P < 0.01). The hip joint score after operation has no statistically significant difference between the two groups (P > 0.05). 3 patients in group B had pin-track infection of grade Ⅱ, and all patients were treated by oral antibiotics and dressing. All patients had no complications such as the loss of fracture position, the withdrawal of screw or the fixed needle, wound infection postoperative and bedsore. Conclusion External fixation is an safe and effective treatment for intertrochanteric fractures in elderly high risk patients. It has advantages include quick and simple application, low risk of anesthesia, short operative time, less bleeding during operation, less radiation exposure, adequate fixation, early discharge from hospital, obvious pain relief and low treatment cost.

Key words： Intertrochanteric fractures External fixator PFNA Harris hip score

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	TIAN Yafeng YAO Xingbao YANG Gang YU Jian ZHU Yanfeng WEN Zhigang HAN Kun

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TIAN Yafeng YAO Xingbao YANG Gang YU Jian ZHU Yanfeng WEN Zhigang HAN Kun. Clincal effect of PFNA and external fixation in elderly patients with highrisk of intertrochanteric fracture[J]. 中国医药导报, 2018, 15(5): 122-126.

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http://www.yiyaodaobao.com.cn/EN/ OR http://www.yiyaodaobao.com.cn/EN/Y2018/V15/I5/122

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