经皮外固定架和PFNA治疗老年高危股骨粗隆间骨折的临床效果[摘要]目的探?并对比经皮外固定架和股骨近端防旋髓内钉（PFNA）在治疗老年高危粗隆间骨折临床效果上的差异。方法选取2015年1月～2017年1月60例河北省中医院骨伤科高龄高危股骨粗隆间骨折患者，其中行外固定架治疗的患者30例（A组），PFNA治疗患者30例（B组）。A组均在局麻下行经皮外固定架治疗；B组在蛛网膜下腔阻滞麻醉或全麻下行PFNA治疗，分别记录两组患者手术前后血红蛋白（Hb）、白蛋白（ALB）的变化，手术时间，术中出血量，术中透视次数，术后卧床时间，术后6个月Harris髋关节评分。结果所有患者术中均获得满意复位，外固定架对A组患者术后平卧和坐卧位活动均无影响。术后两组患者Hb及ALB下降程度比较，差异均有统计学意义（P<0.05）。两组患者手术时间、术中出血量、术中透视次数、住院天数比较，差异均有统计学意义（P<0.01）。术后髋关节评分情况比较，差异无统计学意义（P>0.05）。其中A组3例患者发生Ⅱ级针道感染，经过积极抗感染和换药后均愈合。所有患者均未发生骨折位置丢失、螺钉或斯氏针退出、术后伤口感染及褥疮等并发症。结论外固定架治疗高龄高危股骨粗隆间骨折是一种安全、有效的治疗方法，其优势包括：简单快捷、麻醉风险低、手术时间短、术中出血少、透视次数少、固定牢固、术后卧床时间短、疼痛缓解明显、治疗成本低等。[关键词]股骨粗隆间骨折；外固定架；股骨近端防旋髓内钉；Harris髋关节评分[]R683.421[文献标识码]A[]1673-7210（2018）02（b）-0122-05[Abstract]ObjectiveToinvestigateandcomparetheclinicalcurativeeffectbetweentheexternalfixationandtheproximalfemoralnailantirotation（PFNA）inhigh-riskelderlypatientswithintertrochantericfracture.MethodsSixtyelderlypatientswithhigh-riskofintertrochantericfractureinDepartmentofOrthopaedicsandTraumatology，HebeiProvincialHospitalofTraditionalChineseMedicinefromJanuary2015toJanuary2017wereselected.Patientsweredividedintwogroupsregardingtotreatment.IngroupA（n=30），allpatientsweretreatedwithexternalfixatorunderlocalanesthesia，whileingroupB（n=30）weretreatedwithPFNAundersubarachnoidanesthesiaorgeneralanesthesia.ThechangesofHbandALBbeforeandafteroperationwererecorded，meanwhiletheoperationtime，theamountofintraoperativebleeding，thenumberofintraoperativefluoroscopy，thebedtimeafteroperation，andtheHarrishipjointscoreat6monthsafteroperationwererecorded.ResultsAllpatientsreceivedsatisfactoryreductionduringoperation，thefixatorwaswellacceptedandnopatienthadsignificantdifficultieswhilesittingorlying.ThedecreaseofHbandALBafteroperationwereloweringroupAthanthatingroupB，andthedifferencebetweenthetwogroupswasstatisticallysignificant（P<0.05）.Theoperationtime，theamountofintraoperativebleeding，thenumberofintraoperativefluoroscopyandthedaysofhospitalizationwerelesseringroupAthanthoseinthegroupB，andthedifferencebetweenthetwogroupswasstatisticallysignificant（P<0.01）.Thehipjointscoreafteroperationhasnostatisticallysignificantdifferencebetweenthetwogroups（P>0.05）.3patientsingroupBhadpin-trackinfectionofgradeⅡ，andallpatientsweretreatedbyoralantibioticsanddressing.Allpatientshadnocomplicationssuchasthelossoffractureposition，thewithdrawalofscreworthefixedneedle，woundinfectionpostoperativeandbedsore.ConclusionExternalfixationisansafeandeffectivetreatmentforintertrochantericfracturesinelderlyhighriskpatients.Ithasadvantagesincludequickandsimpleapplication，lowriskofanesthesia，shortoperativetime，lessbleedingduringoperation，lessradiationexposure，adequatefixation，earlydischargefromhospital，obviouspainreliefandlowtreatmentcost.[Keywords]Intertrochantericfrac...