CAJ | 학술논문

目的：探讨在股骨近端防旋髓内钉（ proximal femoral nail anti-rotation，PFNA）治疗股骨转子间骨折的手术中，应用改良的经皮导入主钉导针结合纯侧位透视技术，简化PFNA操作步骤。方法：选择2011年3月至2014年5月在北京大学人民医院创伤骨科，采用常规PFNA内固定技术与改良的经皮导入导针结合纯侧卧透视的PFNA内固定技术治疗股骨转子间骨折病例进行回顾性分析，对随访到的共60例患者，分析其手术时间、术中出血量、术中透视时间、尖顶距、骨折愈合时间和髋关节评分等指标。结果：经皮导入导针结合纯侧卧透视的改良PFNA内固定组的手术时间、术中出血量和术中透视时间分别为（70．5±12．5） min、（34．9±6．1） mL、（63．6±9．7） s，常规PF-NA内固定组则为（80．6±17．1） min、（47．8±6．7） mL、（68．5±8．7） s，两组之间差异有统计学意义（P分别为0．006、0．013、0．022）。在尖顶距、术后髋关节功能和骨折愈合时间等方面，两组之间差异无统计学意义（ P＞0．05）。结论：转子尖处的骨折线对于部分转子间骨折可能是一个天然的进针点，经皮先导入主钉导针结合术中纯侧位透视，可明显减少手术时间、出血量和术中透视时间，使PFNA操作更简单有效。
목적：탐토재고골근단방선수내정（ proximal femoral nail anti-rotation，PFNA）치료고골전자간골절적수술중，응용개량적경피도입주정도침결합순측위투시기술，간화PFNA조작보취。방법：선택2011년3월지2014년5월재북경대학인민의원창상골과，채용상규PFNA내고정기술여개량적경피도입도침결합순측와투시적PFNA내고정기술치료고골전자간골절병례진행회고성분석，대수방도적공60례환자，분석기수술시간、술중출혈량、술중투시시간、첨정거、골절유합시간화관관절평분등지표。결과：경피도입도침결합순측와투시적개량PFNA내고정조적수술시간、술중출혈량화술중투시시간분별위（70．5±12．5） min、（34．9±6．1） mL、（63．6±9．7） s，상규PF-NA내고정조칙위（80．6±17．1） min、（47．8±6．7） mL、（68．5±8．7） s，량조지간차이유통계학의의（P분별위0．006、0．013、0．022）。재첨정거、술후관관절공능화골절유합시간등방면，량조지간차이무통계학의의（ P＞0．05）。결론：전자첨처적골절선대우부분전자간골절가능시일개천연적진침점，경피선도입주정도침결합술중순측위투시，가명현감소수술시간、출혈량화술중투시시간，사PFNA조작경간단유효。
Objective:To apply modified proximal femoral nail anti-rotation ( PFNA ) fixation tech-niques performed by percutaneous placement of guide wire combined with true lateral view and to make the procedures simpler.Methods:A retrospective study was used to analyze the clinical data of femoral intertrochanteric fractures cases, which were treated with conventional PFNA fixation or modified PFNA fixation performed by percutaneous placement guide wire combined with true lateral view in our hospital, from March, 2011 to May, 2014.In the study, 60 cases were followed for average 13 months.The oper-ation time, the amount of bleeding, the fluoroscopy time, postoperative radiographic measurements ( tip apex distance, TAD ) and hip function scores were analyzed.Results:In modified PFNA group, the amount of bleeding, the operation time and the fluoroscopy time were (70.5 ±12.5) min, (34.9 ±6.1) mL, ( 63.6 ±9.7 ) s respectively.In conventional PFNA group, they were ( 80.6 ±17.1 ) min, (47.8 ±6.7) mL, (68.5 ±8.7) s respectively.There were significant differences in the above respects between the two groups (P were 0.006, 0.013, and 0.022 respectively).There were no significant differences in TAD, fracture healing time, postoperative hip scores between the two groups (P>0.05). Conclusion:Fracture line is a natural entry point for some cases of femoral intertrochanteric fractures when we use proximal femoral nail anti-rotation to fix the fracture.Applying percutaneous insertion of the guide pin combined with true lateral view could reduce the operation time, amount of bleeding, and fluo-roscopy time significantly, make the procedures simpler and acquire satisfactory results .