| 白彬彬,周光伟,彭伟雄.老年不稳定型股骨粗隆间骨折患者以不同体位行股骨近端防旋髓内钉内固定治疗的效果比较[J].中国临床保健杂志,2025,28(6):833-837. |
| 老年不稳定型股骨粗隆间骨折患者以不同体位行股骨近端防旋髓内钉内固定治疗的效果比较 |
| Comparison of the effects of internal fixation with proximal femoral anti-rotation nails in different body positions for elderly patients with unstable intertrochanteric fractures of the femur |
| 投稿时间：2025-07-03 |
| DOI：10.3969/J.issn.1672-6790.2025.06.019 |
| 中文关键词: 股骨骨折 骨折固定术,髓内 体位 老年人 |
| 英文关键词: Femoral fractures Fracture fixation,intramedullary Posture Aged 〖FL |
| 基金项目: |
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| 摘要点击次数: 35 |
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| 中文摘要: |
| 目的 探讨老年不稳定型股骨粗隆间骨折(IFF)患者采用不同体位进行股骨近端防旋髓内钉(PFNA)内固定治疗的效果。方法 采用随机对照试验。选取2023年3月至2024年3月在温州市中医院接受治疗的87例老年不稳定型IFF患者。按随机数字表法分为仰卧位组(44例)和侧卧位组(43例)。仰卧位组采用仰卧位辅助牵引床牵引进行PFNA内固定治疗,侧卧位组采用健侧卧位辅助手法牵引复位进行PFNA内固定治疗。2组均随访12个月,其中仰卧位组失访3例,侧卧位组失访2例,最终纳入仰卧位组(41例)和侧卧位组(41例)。比较2组围术期指标、术后12个月的复位情况、髋关节功能优良率,术前与术后7 d的应激反应及骨代谢指标、随访期间的并发症。结果 相比于仰卧位组,侧卧位组切口长度、体位摆放时间、手术时间及术后下床活动时间更短,透视次数、术中出血量更少(P<0.05)。术后12个月,侧卧位组和仰卧位组复位情况比较,差异无统计学意义(P>0.05)。术后12个月,侧卧位组髋关节功能优良率更高(P<0.05)。与术前比较,术后7 d,2组应激反应指标均升高,但侧卧位组比仰卧位组低(P<0.05)；2组血清甲状旁腺激素、骨特异性碱性磷酸酶水平均升高,血清抗酒石酸酸性磷酸酶5b水平均降低,但2组术后差异无统计学意义(P>0.05)。2组随访期间的并发症发生率差异无统计学意义(P>0.05)。结论 侧卧位和仰卧位行PFNA内固定治疗均可改善老年IFF患者骨代谢及复位效果,安全性良好。相比于仰卧位,侧卧位治疗围术期指标更具优势,并可有效减轻患者应激反应,提高患者髋关节功能。 |
| 英文摘要: |
| Objective To explore the effect of using different positions for proximal femoral anti rotation (PFNA) intramedullary nail fixation in elderly patients with unstable intertrochanteric fractures (IFF).Methods A randomized controlled trial was conducted.Eighty-seven elderly patients with unstable intertrochanteric fractures (IFF) who underwent treatment at Wenzhou Traditional Chinese Medicine Hospital from March 2023 to March 2024 were selected.They were divided into a supine position group (44 cases) and a lateral position group (43 cases) according to a random number table method.The supine position group underwent PFNA internal fixation treatment with the assistance of a traction bed in the supine position,while the lateral position group underwent PFNA internal fixation treatment with the assistance of manual traction reduction in the healthy lateral position.Both groups were followed up for 12 months.Among them,3 cases in the supine position group and 2 cases in the lateral position group were lost to follow-up,resulting in the final inclusion of 41 cases in the supine position group and 41 cases in the lateral position group.The perioperative indicators,reduction status at 12 months after surgery,excellent and good rate of hip joint function,stress response and bone metabolic indicators before and 7 d after surgery,as well as complications during the follow-up period were compared between the two groups.Results Compared with the supine position group,the incision length,position placement time,surgical time,and postoperative mobilization time of the lateral position group were shorter,and the number of fluoroscopy sessions and intraoperative bleeding were less (P<0.05).There was no difference in the reduction of lateral and supine positions 12 months after surgery (P>0.05).12 months after surgery,the excellent and good hip joint function rate in the lateral position group was higher (P<0.05).Compared with before surgery,7 d after surgery,the stress response indicators increased in both groups,but the lateral position group were lower (P<0.05);The levels of serum parathyroid hormone (PTH) and bone specific alkaline phosphatase increased in both groups,while the levels of serum tartrate resistant acid phosphatase 5b decreased.However,there was no difference between the two groups (P>0.05).There was no difference of the incidence of complications between the two groups (P>0.05).Conclusions Both lateral and supine positions of PFNA intramedullary nail fixation could improve bone metabolism and reduction effect in elderly patients with IFF,with good safety.Compared with supine position,lateral position treatment had more advantages in perioperative indicators and could effectively reduce patient stress response and improve hip joint function. |
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