| 局麻下股骨近端防旋髓内钉治疗高危患者股骨转子间骨折 |
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投稿时间：2019-12-14
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| 作者 | Author | 单位 | Address | E-Mail |
| 乔梁 |
QIAO Liang |
徐州医科大学第二附属医院 徐州矿务集团总医院 骨科, 江苏 徐州 221006 |
Department of Orthopaedics, the Second Affiliated Hospital of Xuzhou Medical University, General Hospital of Xuzhou Mining Group, Xuzhou 221006, Jiangsu, China |
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| 曹贞国 |
CAO Zhen-guo |
徐州医科大学第二附属医院 徐州矿务集团总医院 骨科, 江苏 徐州 221006 |
Department of Orthopaedics, the Second Affiliated Hospital of Xuzhou Medical University, General Hospital of Xuzhou Mining Group, Xuzhou 221006, Jiangsu, China |
orthopa@163.com |
| 李华 |
LI Hua |
徐州医科大学第二附属医院 徐州矿务集团总医院 骨科, 江苏 徐州 221006 |
Department of Orthopaedics, the Second Affiliated Hospital of Xuzhou Medical University, General Hospital of Xuzhou Mining Group, Xuzhou 221006, Jiangsu, China |
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| 葛行新 |
GE Xing-xin |
徐州医科大学第二附属医院 徐州矿务集团总医院 骨科, 江苏 徐州 221006 |
Department of Orthopaedics, the Second Affiliated Hospital of Xuzhou Medical University, General Hospital of Xuzhou Mining Group, Xuzhou 221006, Jiangsu, China |
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| 张姚 |
ZHANG Yao |
徐州医科大学第二附属医院 徐州矿务集团总医院 骨科, 江苏 徐州 221006 |
Department of Orthopaedics, the Second Affiliated Hospital of Xuzhou Medical University, General Hospital of Xuzhou Mining Group, Xuzhou 221006, Jiangsu, China |
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| 魏东 |
WEI Dong |
徐州医科大学第二附属医院 徐州矿务集团总医院 骨科, 江苏 徐州 221006 |
Department of Orthopaedics, the Second Affiliated Hospital of Xuzhou Medical University, General Hospital of Xuzhou Mining Group, Xuzhou 221006, Jiangsu, China |
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| 期刊信息：《中国骨伤》2020年，第33卷，第4期，第317-321页 |
| DOI：10.12200/j.issn.1003-0034.2020.04.006 |
| 基金项目: |
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中文摘要:
目的：比较局麻和全麻下行股骨近端防旋髓内钉（proximal femoral nail anti-rotation，PFNA）治疗高危患者股骨转子间骨折的临床疗效。
方法：2018年2月至2019年2月因股骨转子间骨折行PFNA手术的32例患者，16例局麻下行PFNA手术，男9例，女7例，年龄54~98（82.43±9.30）岁，住院时间（10.94±5.30） d；16例全麻下行PFNA手术，男6例，女10例，年龄51~83（72.69±9.48）岁，住院时间（12.88±4.12） d。记录患者性别、年龄、骨折AO分型、术前VAS疼痛评分、术前ASA病情分级、术后第1天静息状态VAS评分、住院费用及住院时长。
结果：32例患者术后均恢复较好，伤口愈合良好，恢复下肢活动能力。患者术后平均随访时间4.6个月。两组患者年龄差异有统计学意义（P<0.05）；患者性别比、骨折AO分型、术前VAS疼痛评分比较，差异无统计学意义（P>0.05）。两组ASA分级比较差异无统计学意义（P>0.05），但两组ASA ≥ Ⅲ级患者比较差异有统计学意义（P<0.05）。局麻组术中VAS疼痛评分4.19±1.50，患者尚可忍受。两组术后第1天静息状态VAS评分、平均住院费用及平均住院时长比较差异无统计学意义（P>0.05）。
结论：多学科诊疗模式下局麻为主的多种镇痛镇静方式下PFNA手术的方法是安全可行的，局麻手术患者年龄更大，并且ASA ≥ Ⅲ级患者的比例更高，对于部分老年高危患者局麻比全麻手术是更好的适应证。 |
| 【关键词】股骨骨折 髋骨折 麻醉,局麻 骨折固定术,髓内 |
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| Proximal femoral nail anti-rotation under local anesthesia for femoral intertrochanteric fractures in high-risk patients |
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ABSTRACT
Objective: To compare the clinical efficacy under local anesthesia and general anesthesia proximal femoral nail anti-rotation(PFNA) fixation for intertrochanteric fracture of femur in high risk patients.
Methods: From February 2018 to February 2019,32 patients underwent PFNA operation due to intertrochanteric fracture of femur,including 16 patients undergoing PFNA operation under local anesthesia,9 males and 7 females,aged 54 to 98(82.43±9.30) years and hospitalized for (10.94±5.30) days;16 patients undergoing PFNA operation under general anesthesia,6 males and 10 females,aged 51 to 83 (72.69±9.48) years and hospitalized for (12.88±4.12) days. The patients' gender,age,fracture AO classification,preoperative VAS(visual analogue score),preoperative ASA condition grade,postoperative 1st day resting state VAS,hospitalization cost and length of stay were recorded.
Results: All patients recovered well,the wound healed well,and the ability of lower limb activity was restored. The average follow-up time was 4.6 months. There was significant difference in age between two groups(P<0.05);there was no significant difference in sex ratio,AO classification of fracture and VAS before operation(P>0.05). There was no significant difference on ASA between two groups (P>0.05),but there was significant difference on ASA ≥ grade Ⅲ between two groups(P<0.05). In local anesthesia group,VAS pain score was 4.19±1.50,which was tolerable. There was no significant difference in postoperative 1st day resting state VAS,average hospitalization cost and average length of stay between two groups(P>0.05).
Conclusion: Under the multi-disciplinary diagnosis and treatment mode,the method of PFNA operation is safe and feasible,the patients with local anesthesia are older,and the proportion of patients with ASA ≥ grade Ⅲ is higher,which is better for some elderly high-risk patients than general anesthesia. |
| KEY WORDS Femoral fractures Hip fractures Anesthesia,local Fracture fixation,intramedullary |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 乔梁,曹贞国,李华,葛行新,张姚,魏东.局麻下股骨近端防旋髓内钉治疗高危患者股骨转子间骨折[J].中国骨伤,2020,33(4):317~321 |
| 英文格式: | QIAO Liang,CAO Zhen-guo,LI Hua,GE Xing-xin,ZHANG Yao,WEI Dong.Proximal femoral nail anti-rotation under local anesthesia for femoral intertrochanteric fractures in high-risk patients[J].zhongguo gu shang / China J Orthop Trauma ,2020,33(4):317~321 |
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