程序化模式治療老年不穩(wěn)定性股骨粗隆間骨折的臨床研究

張興國　王忠偉　王德成

【摘要】 目的：探討程序化模式治療老年不穩(wěn)定型股骨粗隆間骨折的療效。方法：依據(jù)Evans分型收集2015年7月-2016年3月收治的老年不穩(wěn)定性股骨粗隆間骨折87例，按照納入及排除標準60例患者納入研究，分為程序化組和對照組，每組各30例。程序化組采用正骨手法整復-牽引床維持外固定-克氏針體外定位-PFNA內(nèi)固定程序化治療方案，對照組采用牽引床復位并PFNA內(nèi)固定。觀察兩組患者的復位時間、主釘入髓時間、手術時間、血回收量、隱性出血、開始抬腿時間、扶拐獨立下地時間，骨折愈合時間、并發(fā)癥，并用Harris評分進行關節(jié)功能分析。結果：隨訪12個月，均骨性愈合，術后無再骨折和切出。兩組患者的骨折復位時間、主釘入髓時間、血回收量、隱性出血、開始抬腿時間、并發(fā)癥比較，差異均有統(tǒng)計學意義（P<0.05）。扶拐獨立下地時間、骨折愈合時間比較，差異均無統(tǒng)計學意義（P>0.05）。根據(jù)改良Harris髖關節(jié)評分標準，程序化組優(yōu)、良、可、差分別為21、6、2、1例，優(yōu)良27例（90%），治愈率97%；對照組分別為11、10、2、7例，21例（70%），77%，兩組優(yōu)良率與治愈率比較，差異均有統(tǒng)計學意義（P<0.05）。結論：對老年不穩(wěn)定性股骨粗隆間骨折程序化模式治療優(yōu)于單純牽引床法，術中筋骨并重，療效滿意，值得推廣。

【關鍵詞】 程序化； PFNA； 股骨粗隆間骨折； 不穩(wěn)定型

【Abstract】 Objective：To investigate the effect of the treatment of unstable femoral intertrochanteric fractures in elderly patients with program mode.Method：According to Evans-Jensen types，from July 2015 to March 2016 treated 87 cases of unstable femoral intertrochanteric hip fractures in elderly patients，according to inclusion and exclusion criteria 60 patients were included in the study，they were divided into procedural group and the control group，30 cases in each group.Procedural group was used to bone setting manipulation-traction bed to maintain external fixation-positioning of Kirschner wire-PFNA，control group was used to traction bed and PFNA.The reset time，enter pulp time，operative time，the blood loss during surgery and cell saver，occult bleeding，the time to lift the leg，crutch independtly time，bone healing time and postoperative complication of two groups were compared.The joint function was analysed by Harris hip score.Result：All the patients were followed up for 12 months，no fracture and cut out after operation.Compared the reset time，enter pulp time，operative time，the blood loss during surgery and cell saver，occult bleeding，the time to lift the leg，crutch independtly，and postoperative complication of two groups，the diffences were statistically significant（P<0.05）.Compared the time of the independent lower ground and fracture healing of two groups，the differences were not statistically significant（P>0.05）.According to the modified Harris hip score，in procedural group the cases of excellent，good，fair and poor were respectively 21，6，2，1，the excellent and good rate was 90%，the cure rate was 97%；the control group were respectively 11，10，2，7，70%，77%，the differences were statistically significant（P<0.05）.Conclusion：The treatment of unstable femoral intertrochanteric fractures in elderly patients with programming mode of PFNA is preferred than simple traction bed reduction at perioperative period， focus on soft tissue and bones in the process，the way is worth promoting by satisfactory efficacy.endprint

【Key words】 Procedural； PFNA； Femoral intertrochanteric fractures； Unstable

First-authors address：The TCM-WM Hospital of Tongzhou，Beijing 101100，China

doi：10.3969/j.issn.1674-4985.2017.25.002

股骨粗隆間骨折易發(fā)生脆性骨折[1]，不穩(wěn)定型經(jīng)常合并多種基礎病，同時產(chǎn)生許多并發(fā)癥，筆者按照快速康復理念要求和將手術治療全程優(yōu)化[2]，形成程序化模式[3]，療效滿意。現(xiàn)報道如下。

1 資料與方法

1.1 一般資料 依據(jù)Evans分型收集2015年

7月-2016年3月收治的股骨粗隆間骨折不穩(wěn)定型的患者87例。符合診斷標準的患者，根據(jù)納入和排除標準共60例作為研究對象，分為程序化組和對照組，每組各30例。……