侧卧位与仰卧位股骨近端抗旋转钉固定粗隆间骨折比较△（开放获取）

Lateral position versus supine counterpart for proximal femoral nail anti-rotation fixation of femoral intertrochanteric fractures

摘要:

[目的]比较仰卧位与侧卧位应用股骨近端防旋髓内钉（proximal femoral nail anti-rotation, PFNA）固定 Evans-Jensen Ⅱ型~R 型股骨转子间骨折的临床疗效。[方法]回顾性分析 2017 年 1 月—2022 年 12 月瑞康医院收治的 306 例 Evans-Jensen Ⅱ ~R 型股骨转子间骨折患者的临床资料。根据术前医患沟通结果，166 例采用侧卧位，另外 140 例采用仰卧位。比较两组围手术期、随访及影像结果。[结果] 全部患者手术顺利，无术中并发症，侧卧组手术时间 [(88.4±19.4) min vs (97.9±22.4) min, P＜ 0.001]、切口总长度 [(6.9±2.0) cm vs (7.5±1.9) cm, P=0.004]、术中失血量 [(107.4±40.1) mL vs (121.3±41.9) mL, P=0.003]、术中透视次数 [(13.5±0.8) 次 vs (15.0±1.2) 次, P＜0.001] 均显著少于仰卧组。两组切口愈合等级、住院时间、下地行走时间的差异均无统计学意义 （P＞0.05）。随访时间平均 （15.2±1.6） 个月。两组完全负重活动时间的差异无统计学意义 （P＞0.05），与术后 6 个月相比，术后 12 个月，两组 VAS、Harris 评分及髋屈伸、髋内外旋 ROM 均显著改善 （P＜0.05）。术后 6、12 个月，侧卧组的髋屈伸 ROM [(99.0±7.4)° vs (96.5±8.9)°, P=0.010; (114.2±9.1)° vs (111.4±9.3)°, P=0.010]、髋内外旋 ROM [(49.9±7.9)° vs (47.0±8.4)°, P= 0.020; (56.0±7.9)° vs (52.7±8.3)°, P＜0.001] 均显著优于仰卧组。影像方面，两组患者 Baumgaertner 分级的差异无统计学意义 （P＞ 0.05），相应时间点，两组颈干角（femoral neck-shaft angle, FNSA）、尖顶距（tip apex disteence, TAD）及骨折愈合时间比较的差异均无统计学意义（P＞0.05）。[结论]侧卧位使用 PFNA-Ⅱ内固定治疗股骨转子间骨折具有操作方便、手术时间短、出血量更少等优点。

Abstract:

[Objective] To compare the clinical efficacy of proximal femoral nail anti-rotation II (PFNA-II) fixation of Evans-Jensen typeⅡto type R femoral intertrochanteric fractures in lateral position versus supine counterpart. [Methods] A retrospectve research was conducted on 306 patients who had Evans-Jensen type II to type R femoral intertrochanteric fractures fixed with PFNA-Ⅱ in Ruikang Hospital from January 2017 to December 2022. According to the preoperative doctor-patient communication, 166 patients had PFNA performed in lateral position (LP), while the remaining 140 patients were in supine position (SP). The documents regarding perioperative period, follow-up and images were compared between the two groups. [Results] All patients in both groups had PFNA performed smoothly without intraoperative complications. The LP group proved significantly superior to the SP group in terms of operation time [(88.4±19.4) min vs (97.9±22.4) min, P＜0.001], total incision length [(6.9±2.0) cm vs (7.5±1.9) cm, P=0.004], intraoperative blood loss [(107.4±40.1) mL vs (121.3±41.9) mL, P=0.003], and intraoperative fluoroscopy times [(13.5±0.8) vs (15.0±1.2), P＜0.001], despite of the fact that there were no significant differences in incision healing grade, hospital stay and ambulation time between the two groups (P＞0.05). The follow-up period lasted for (15.2±1.6) months in a mean, and there was no a significant difference in the time to resume full weight-bearing activity between the two groups (P＞0.05). Compared with those 6 months after surgery, the VAS, Harris scores, as well as hip flexion-extension range of motion (ROM) and hip internal-external rotation ROM were significantly improved in both groups 12 months after surgery (P＜0.05). At 6 and 12 months after operation, the LP group achieved significantly greater flexion-extension ROM [(99.0±7.4)° vs (96.5±8.9)°, P=0.010; (114.2±9.1)° vs (111.4±9.3)°, P=0.010] and internal-external rotation ROM [(49.9±7.9)° vs (47.0±8.4)°, P=0.020; (56.0±7.9)° vs (52.7±8.3)°, P＜ 0.001] than the SP group. Regarding imaging, there was no any statistically significant differences in terms of Baumgaertner's fracture reduction grade, and femoral neck-shaft angle (FNSA), tip apex distance (TAD) and fracture healing time between the two groups (P＞0.05). [Conclusion] The lateral position takes the advantages of convenient operation, shorter operation time and less bleeding for PFNA-Ⅱ fixation of femoral intertrochanteric fractures over the supine position