| Back ground It is well-known that elderly intertrochanteric fractures are more common in daily life,mostly elderly patients,and often due to varying degrees of osteoporosis,hypertension and diabetes and other chronic diseases,the treatment of fractures proposed a higher claim.Statistical analysis shows that surgical treatment can reduce the mortality and complications caused by fracture,which is obviously better than non-surgical treatment.Choosing the appropriate surgical method is the key to fracture reduction and internal fixation.Proximal femoral nail antirotation(PFNA))treatment of femoral intertrochanteric fractures more advantages,is conducive to reducing postoperative infection rate,reducing trauma and bleeding,which became The ideal surgical approach.At present,the main PFNA surgery position is supine and needs to be completed with the cooperation of the orthopedic traction bed,which is not universal in many primary hospitals.Moreover,the use of an orthopedic traction bed can cause certain complications such as perineal skin tearing,Nerve dysfunction and so on.Some investigators used lateral PFNA internal fixation in the treatment of intertrochanteric fractures,and achieved good clinical efficacy.The previous study shows that our group,through the "quick diagnosis and treatment access" can effectively reduce the elderly patients with hip fracture 1 year after the death rate,then the subject retrospectively analyzed through the "quick diagnosis and treatment of access" in our department PFNA internal fixation in the treatment of patients with intertrochanteric fractures,including 55 cases of supine position,53 cases of lateral position,in order to compare the clinical efficacy of different positions,to provide the basis for clinical options.Objective To investigate the clinical efficacy of PFNA in the treatment of intertrochanteric fractures in lateral and supine position through the "quick diagnosis and treatment access" in our department for the treatment of femoral intertrochanteric fractures in our department.Methods Retrospective analysis of 108 cases of intertrochanteric fractures treated by PFNA in our department between January 2015 and December 2016 through the "quick diagnosis and treatment channel" were performed intraoperatively The body position is divided into supine group(55 cases),lateral group(53 cases).Assessment of the two groups of patients with a comprehensive condition,and actively correct the underlying diseases to meet the surgical conditions,postoperative conventional anticoagulation,functional exercise,and timely weight-bearing.The clinical assessment indexes included operation time,intraoperative blood loss,incision length,number of intraoperative fluoroscopy,fracture healing time,short-term and long-term postoperative complications,and preoperative,postoperative 1 month,postoperative 6 months,Harris functional score of hip after 12 months.Results 1.Comparison of the general situation of two groups of patients:Comparing the general data of gender,age,fracture AO classification and medical diseases,the analysis showed no significant difference(P>0.05),comparable.2.Compared with the supine group,the operation time,intraoperative blood loss,length of incision and the number of fluoroscopy were significantly lower in the lateral group than those in the supine group,the difference was statistically significant(P<0.05)X-ray showed complete disappearance of the fracture line,the limb burden of pain-free,can withstand longitudinal stress without discomfort,fracture healing standards,the two groups of patients with fracture healing time,the values were similar,the difference was not statistically significant(P>0.05).3.Short-term postoperative complications:comparative analysis of the two groups of recent complication data,the difference was not statistically significant(P>0.05).In this study,no pulmonary infection and urinary tract infection,lower extremity venous thrombosis in patients,both groups of patients with postoperative pain in limbs,were supine group in 3 cases,2 cases of lateral group,after a period of self-cultivation No discomfort after time;supine group had 2 cases of perineal ecchymosis,not improve after nursing bedsore,and gradually recovered,lateral perineal ecchymosis did not appear;two groups of limited incision fat liquefaction Patients were obese patients,supine group in 3 cases,lateral group of 4 cases,after dressing were healed.There was no significant difference between the two groups in recent complication and complication rates(P>0.05).4.Long-term postoperative complications:There was no statistically significant difference in long-term complications such as loose staples,spiral incision or extrusion,nonunion,or varus valgus in both groups).5.Harris function score comparison:The two groups of patients before surgery,1 month after surgery,6 months after surgery,12 months after the Harris hip score.There was no significant difference in Harris functional score between the two groups before surgery(P>0.05).One month after surgery,the hip Harris function score was 59.6±8.1 in the supine group and 66.7 ±9.1 in the lateral group,with significant difference(P<0.05),indicating that the comprehensive hip function was better in the lateral group Supine group,recovery is better.6 months after re-evaluation,supine group was 69.8±8.6,lateral group was 74.8± 9.3,the difference between the two was statistically significant(P<0.05),indicating that lateral hip function is still better than Supine group.However,in the 12-month postoperative hip Harris function score,the supine group was 86.3±8.2,the lateral group was 88.9±8.7,there was no significant difference between the two(P>0.05),indicating that after a reasonable and effective After exercise and enough time to recover,both groups of patients had a good recovery of hip function.Harris function scores of hip joint in one group,one month after operation,six months after operation and 12 months after operation were significantly higher than those before operation(P<0.05).Conclusion Through the "quick diagnosis and treatment channel",compared with the supine position,the use of lateral position has the advantages of reducing trauma,blood loss during operation,operating time and other advantages in the treatment of intertrochanteric fractures requiring PFNA surgery.In complications and fractures Healing time,no significant difference in hip function recovery.But the lateral position does not require orthopedic traction bed,more convenient than the supine position to promote,more advantages. |
PDF Full Text Request