程序化模式治疗老年不稳定性股骨粗隆间骨折的临床研究

张兴国　王忠伟　王德成

【摘要】 目的：探討程序化模式治疗老年不稳定型股骨粗隆间骨折的疗效。方法：依据Evans分型收集2015年7月-2016年3月收治的老年不稳定性股骨粗隆间骨折87例，按照纳入及排除标准60例患者纳入研究，分为程序化组和对照组，每组各30例。程序化组采用正骨手法整复-牵引床维持外固定-克氏针体外定位-PFNA内固定程序化治疗方案，对照组采用牵引床复位并PFNA内固定。观察两组患者的复位时间、主钉入髓时间、手术时间、血回收量、隐性出血、开始抬腿时间、扶拐独立下地时间，骨折愈合时间、并发症，并用Harris评分进行关节功能分析。结果：随访12个月，均骨性愈合，术后无再骨折和切出。两组患者的骨折复位时间、主钉入髓时间、血回收量、隐性出血、开始抬腿时间、并发症比较，差异均有统计学意义（P<0.05）。扶拐独立下地时间、骨折愈合时间比较，差异均无统计学意义（P>0.05）。根据改良Harris髋关节评分标准，程序化组优、良、可、差分别为21、6、2、1例，优良27例（90%），治愈率97%；对照组分别为11、10、2、7例，21例（70%），77%，两组优良率与治愈率比较，差异均有统计学意义（P<0.05）。结论：对老年不稳定性股骨粗隆间骨折程序化模式治疗优于单纯牵引床法，术中筋骨并重，疗效满意，值得推广。

【关键词】 程序化； PFNA； 股骨粗隆间骨折； 不稳定型

【Abstract】 Objective：To investigate the effect of the treatment of unstable femoral intertrochanteric fractures in elderly patients with program mode.Method：According to Evans-Jensen types，from July 2015 to March 2016 treated 87 cases of unstable femoral intertrochanteric hip fractures in elderly patients，according to inclusion and exclusion criteria 60 patients were included in the study，they were divided into procedural group and the control group，30 cases in each group.Procedural group was used to bone setting manipulation-traction bed to maintain external fixation-positioning of Kirschner wire-PFNA，control group was used to traction bed and PFNA.The reset time，enter pulp time，operative time，the blood loss during surgery and cell saver，occult bleeding，the time to lift the leg，crutch independtly time，bone healing time and postoperative complication of two groups were compared.The joint function was analysed by Harris hip score.Result：All the patients were followed up for 12 months，no fracture and cut out after operation.Compared the reset time，enter pulp time，operative time，the blood loss during surgery and cell saver，occult bleeding，the time to lift the leg，crutch independtly，and postoperative complication of two groups，the diffences were statistically significant（P<0.05）.Compared the time of the independent lower ground and fracture healing of two groups，the differences were not statistically significant（P>0.05）.According to the modified Harris hip score，in procedural group the cases of excellent，good，fair and poor were respectively 21，6，2，1，the excellent and good rate was 90%，the cure rate was 97%；the control group were respectively 11，10，2，7，70%，77%，the differences were statistically significant（P<0.05）.Conclusion：The treatment of unstable femoral intertrochanteric fractures in elderly patients with programming mode of PFNA is preferred than simple traction bed reduction at perioperative period， focus on soft tissue and bones in the process，the way is worth promoting by satisfactory efficacy.endprint

【Key words】 Procedural； PFNA； Femoral intertrochanteric fractures； Unstable

First-authors address：The TCM-WM Hospital of Tongzhou，Beijing 101100，China

doi：10.3969/j.issn.1674-4985.2017.25.002

股骨粗隆间骨折易发生脆性骨折[1]，不稳定型经常合并多种基础病，同时产生许多并发症，笔者按照快速康复理念要求和将手术治疗全程优化[2]，形成程序化模式[3]，疗效满意。现报道如下。

1 资料与方法

1.1 一般资料 依据Evans分型收集2015年

7月-2016年3月收治的股骨粗隆间骨折不稳定型的患者87例。符合诊断标准的患者，根据纳入和排除标准共60例作为研究对象，分为程序化组和对照组，每组各30例。……