吴侃　李黎　杨家赵　方诗元

摘 要：目的 探讨侧卧位和仰卧位对股骨近端抗旋髓内钉手术治疗股骨粗隆间骨折的临床疗效比较。方法 收集我院通过“快速诊治通道”行PFNA手术的36例股骨粗隆间骨折患者的临床资料，按术中采用的体位分为仰卧组17例和侧卧组19例。临床评估指标包括手术时间、术中失血量、手術切口长度、透视次数、骨折临床愈合时间、术后1年的Harris髋关节功能评分、术后并发症发生率。结果 侧卧组患者的手术时间、术中失血量、手术切口长度、术中透视次数均少于仰卧组，差异有统计学意义（P<0.05），而在骨折愈合时间、术后1年的Harris髋关节功能评分和术后并发症发生率方面相比较，差异无统计学意义（P>0.05）。结论 通过“快速诊治通道”，对于需要行PFNA手术治疗的股骨粗隆间骨折，与采用仰卧位相比，采用侧卧位具有减少创伤、出血等优势。

关键词：股骨粗隆间骨折；股骨近端防旋髓内钉；体位；快速通道

中图分类号：R687.3 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.11.024

文章编号：1006-1959（2018）11-0076-04

Comparison of Clinical Effects between Supine Position and Lateral Decubitus PFNA in the Treatment of Intertrochanteric Fractures in the Elderly

WU Kan，LI Li，YANG Jia-zhao，FANG Shi-yuan

（Department of Traumatic Orthopaedics，Anhui Provincial Hospital Affiliated to Anhui Medical University，Hefei 230001，Anhui，China）

Abstract：Objective To investigate the clinical efficacy of lateral femoral nail and supine position in the treatment of femoral intertrochanteric fracture with proximal femoral nail.Methods The clinical data of 36 patients with femoral intertrochanteric fractures who underwent PFNA surgery through the"rapid diagnosis and treatment channel"were collected.According to the position used during surgery，17 cases were included in the supine group and 17 cases in the lateral group.Clinical assessment indicators included operative time，intraoperative blood loss，surgical incision length，fluoroscopic times，clinical fracture healing time，Harris hip function score at 1 year postoperatively，and incidence of postoperative complications.Results The operative time，intraoperative blood loss，surgical incision length，and intraoperative fluoroscopy times were lower in the lateral group than those in the supine group，the difference was statistically significant（P<0.05）.There was no statistically significant difference in fracture healing time，Harris hip function score and postoperative complications at 1 year after surgery，the difference was not statistically significant（P>0.05）.Conclusion Through the"rapid diagnosis and treatment channel"，for femoral intertrochanteric fractures requiring PFNA surgery，the use of lateral decubitus position has the advantage of reducing trauma and hemorrhage compared with supine position.

Key words：Intertrochanteric fracture；Proximal femoral nail anti rotation；Body position；Rapid channel

股骨粗隆间骨折（intertrochanteric fracture）在日常生活中较为常见，目前研究认为[1]，股骨近端抗旋髓内钉（PFNA）手术治疗股骨粗隆间骨折更具优势。目前主要的PFNA手术体位为仰卧位，需要在骨科牵引床的配合下完成，这在很多基层医院无法普及。本课题组既往研究表明[2]，通过“快速诊治通道”，可以有效降低老年髋部骨折患者术后1年的死亡率，遂本课题回顾性分析2015年1月～2016年12月期间，通过“快速诊治通道”，在我科接受治疗并获得随访的36例采用PFNA内固定术治疗股骨粗隆间骨折的患者，以比较不同体位的临床疗效，为临床选择提供依据。

1资料与方法

1.1一般资料 选取2015年1月～2016年12月于安徽医科大学附属安徽省立医院就诊的股骨粗隆间骨折患者36例，本研究经医院伦理委员会批准。……