摘要
目的探讨股骨近端防旋髓内钉(PFNA)结合钢丝环扎与股骨近端锁定加压板(PF-LCP)治疗复杂股骨粗隆下骨折的临床效果。方法回顾研究2015年5月—2017年5月在笔者医院治疗的复杂股骨粗隆下骨折患者60例,男性28例,女性32例;年龄32～88岁,平均62岁;骨折按Seinsheiner分型:ⅢA型12例,Ⅳ型18例,Ⅴ型30例; PFNA结合钢丝环扎38例,PF-LCP治疗22例,均顺利完成手术。对比两组患者的手术时间、术中出血量、骨折愈合时间、术后严重并发症、术后1个月疼痛VAS评分和3个月髋关节Harris评分情况。结果 60例患者均获随访,平均(10. 56±4. 23)个月。两组患者手术时间、术中出血量和骨折愈合时间比较差异无统计学意义(P> 0. 05),PF-LCP组术后1个月时疼痛VAS评分及3个月时髋关节Harris评分低于PFNA结合钢丝环扎组,差异有统计学意义(P <0. 05)。PFNA结合钢丝环扎组1例内固定失败,PF-LCP组3例内固定失败,两组患者并发症发生率比较差异有统计学意义(P <0. 05)。结论 PFNA结合钢丝环扎在复杂股骨粗隆下粉碎性骨折的应用中能较好解决骨折复位困难的问题,并且固定坚强,符合生物力学要求,是治疗复杂股骨粗隆下骨折的优选手术方法。
Objective To evaluate the clinical outcomes of two fixation options for complex subtrochanteric fractures using proximal femoral nail antirotation(PFNA)combined with steel wire cerclage and proximal femoral locking compression plate(PFLCP).Methods Sixty cases of complex subtrochanteric fractures who were admitted into our hospital from May2015to May2017were retrospectively analyzed.There were27males and33females,with a mean age of62years(range from32to88years).According to the different types of Seinsheimer,12were with typeⅢA,18were with typeⅣand30were with typeⅤ.All the patients successfully completed the operation,including38cases treated by PFNA combined with steel wire cerclage and22cases treated by PFLCP.The operation time,blood loss,fracture healing time,postoperative complication,VAS score at postoperative1month and Harris score at postoperative3months were compared between the two groups.Results All of the60patients were followed up for(10.56±4.23)months.No significant difference was found between the two groups in the operation time,blood loss and fracture healing time(P>0.05).There were statistical differences between the two groups in VAS sore at1month and Harris score3months after operation(P<0.05).The difference in the postoperative complications rate was statistically significant between the two groups(P<0.05).Conclusion Steel wire cerclage used as an adjunct to PFNA can better solve the problem of fracture dislocation,afford excellent reductions and a high union rate,which is an ideal method for treating complex subtrochanteric fractures.
作者
陆博
王业华
蒋健
颜宸
LU Bo;WANG Ye-hua;JIANG Jian;YAN Chen(The Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221000,China)
出处
《创伤外科杂志》
2018年第12期913-915,共3页
Journal of Traumatic Surgery
关键词
股骨粗隆下骨折
髓内钉
加压板
钢丝环扎
内固定
femoral subtrochanteric fractures
intramedullary nail
compression plate
steel wire cerclage
internal fixation
