经皮外固定架和pfna治疗老年高危股骨粗隆间骨折临床效果.docVIP

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 　　[摘要] 目的 探?并对比经皮外固定架和股骨近端防旋髓内钉（PFNA）在治疗老年高危粗隆间骨折临床效果上的差异。 方法 选取2015年1月～2017年1月60例河北省中医院骨伤科高龄高危股骨粗隆间骨折患者，其中行外固定架治疗的患者30例（A组），PFNA治疗患者30例（B组）。A组均在局麻下行经皮外固定架治疗；B组在蛛网膜下腔阻滞麻醉或全麻下行PFNA治疗，分别记录两组患者手术前后血红蛋白（Hb）、白蛋白（ALB）的变化，手术时间，术中出血量，术中透视次数，术后卧床时间，术后6个月Harris髋关节评分。 结果 所有患者术中均获得满意复位，外固定架对A组患者术后平卧和坐卧位活动均无影响。术后两组患者Hb及ALB下降程度比较，差异均有统计学意义（P 0.05）。其中A组3例患者发生Ⅱ级针道感染，经过积极抗感染和换药后均愈合。所有患者均未发生骨折位置丢失、螺钉或斯氏针退出、术后伤口感染及褥疮等并发症。 结论 外固定架治疗高龄高危股骨粗隆间骨折是一种安全、有效的治疗方法，其优势包括：简单快捷、麻醉风险低、手术时间短、术中出血少、透视次数少、固定牢固、术后卧床时间短、疼痛缓解明显、治疗成本低等。 　　[关键词] 股骨粗隆间骨折；外固定架；股骨近端防旋髓内钉；Harris髋关节评分 　　[中图分类号] R683.421 [文献标识码] A [文章编号] 1673-7210（2018）02（b）-0122-05 　　[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）. 3 patients in group B had