张剑锋　杨伟臻　李文琴

【摘要】 目的：探讨侧卧位手法牵引复位技术在股骨近端防旋髓內钉固定不稳定型股骨转子间骨折的应用成效。方法：回顾性分析2014年1月-2015年5月收治的44例不稳定型的股骨转子间骨折患者的资料，根据骨折复位方法的不同分为侧卧位手法牵引复位组（A组）和牵引床牵引复位组（B组），每组22例。分析比较两组患者骨折复位效果、术中出血量、手术时间、骨折愈合时间、随访时间、闭合复位失败率及术后1年Harris评分。结果：两组患者复位效果、术中出血量、手术时间及术后1年Harris评分比较差异均有统计学意义（P<0.05），而骨折愈合时间、随访时间和闭合复位失败率比较差异均无统计学意义（P>0.05）。结论：对于不稳定型股骨转子间骨折，侧卧位牵引复位技术具有操作简单、术中出血量少、手术时间短、复位效果好等特点，值得临床推广应用。

【关键词】 股骨转子间骨折； 不稳定型； 侧卧位； 手法牵引复位； 临床疗效

【Abstract】 Objective：To explore the outcome of proximal femur nail anti-rotation （PFNA） on patients with unstable intertrochanteric fracture in lateral position.Method：From January 2014 to May 2015，44 cases of unstable intertrochanteric fractures treated with PFNA were selected.They were divided into two groups according to different treatment way，22 cases in each group.Group A received manual reduction in lateral position，while group B received reduction on a traction bed in horizontal position.The quality of fracture reduction，intraoperative blood loss，operation time， healing time，follow-up time，failure rate of reduction and Harris scores one year post-operation of two groups were recorded.Result：The differences showed statistically significant of the quality of fracture reduction，operation time，intraoperative blood loss and Harris scores one year post-operation between two groups（P<0.05），while healing time，follow-up time and failure rate of reduction in two groups the differences did not statistically significant（P>0.05）.Conclusion：Compared with reduction on a traction bed in horizontal position，manual reduction in lateral position used in unstable intertrochanteric fracture patients decreases operative difficulties，saves operation time and reduces intraoperative hemorrhage，has an obvious advantage and wider clinical application prospect.

【Key words】 Intertrochanteric fracture； Unstable intertrochanteric fracture； Lateral position； Manual reduction； Clinical effect

First-authors address：Yunlong Orthopaedic Hospital of Baotou，Baotou 014010，China

doi：10.3969/j.issn.1674-4985.2017.04.017

股骨转子间骨折是股骨颈基底部关节囊远端与小转子水平线之间的骨折，骨折线常横过大小转子间或沿转子间嵴走行，一般不穿越两转子，是常见的髋部骨折之一[1-3]。目前临床上公认的治疗原则是良好的内固定和早期的功能锻炼[4-5]。一般的股骨转子间骨折移位均可通过牵引床牵引复位得到纠正，但对于一些像A2、A3型的股骨转子间骨折由于骨折类型复杂，骨折端不稳定，牵引床复位难度较大，效果较差。笔者在既往临床实践中尝试侧卧位手法牵引复位治疗这一类型的骨折，发现侧卧位手法牵引复位较牵引床牵引复位更具优势，现将具体手术治疗方法和研究结果报道如下。……