| Objectives To analyze and improvement of the operation steps of proximal al femoral nail antirotation(PFNA)in orthopedic traction bed,whether the operation time of traction bed and intraoperative fluoroscopy can be effectively reduced was discussed,so as to better promote its application in clinical practice.Methods To choose from January 2016 to March 2019 in YanBian University Hospital for intertrochanteric fractures and hospitalized in our department PFNA surgical treatment of 120 patients older than 65 years old(including 65 years old)and under 95 years old(including 95 years old)and divided into three groups:A,B and C.In group A,there were 45 cases of traction bed improvement procedure group,in group B,there were 45 cases of traction bed traditional procedure group,and in group C,there were 30 cases of lateral position group.There were 31 females and 14 males in group A(traction bed step improvement group),with an average age of(78.76±6.43)years old.According to Evans classification,0 females were of type Ⅰ,5 males were of type Ⅱ,22 males were of type Ⅲ,10 males were of type Ⅳ,and 8 females were of type Ⅴ.There were 32 females and 13 males in group B(traction bed traditional step group),with an average age of(80.91±5.24)years old.According to Evans classification,there were 0 females of type Ⅰ,4 males of type Ⅱ,20 males of type Ⅲ,14 males of type Ⅳ,and 7 males of type Ⅴ.In group C(lateral position),there were 20 females and 10 males,with an average age of(81.27±4.83)years.According to Evans classification,there were 0 patients of type Ⅰ,5patients of type Ⅱ,10 patients of type Ⅲ,8 patients of type Ⅳ,and 7 patients of type Ⅴ.Six steps were taken to record and analyze the operation process of group A and group B,including traction bed preparation time,c-arm placement time,intramedullary nailing,spiral blade,horizontal locking nailing and tail cap(Pay attention to cover the patient’s upper body and thyroid gland with lead clothes before operation),The movement times and fluoroscopy times of c-arm in groups A,B and C were recorded indetail.respectively.Comparing group A and group B patients six steps,mobile number and number of intraoperative fluoroscopy C arm,etc.,with 1 day,3 day,5 days after the VAS score,and postoperative follow-up of 1 month,3 months,6 months,12 months after the hip joint in patients with Merle D Aubigne score,Harris hip score,fracture healing time comparing group A and group B;The operation time,reduction time,postural preparation time and Harris score of postoperative follow-up were comp ared between group A and group C.Result1.Comparison of the general situation of patients:the age,gender,fracture Evans type and the general operation data of the three groups before and after the improvement of surgical procedures were compared,and the analysis showed that the difference was not statistically significant(P>0.05),indicating comparability2.Surgery paragraphs time comparison:group A(traction bed process improvement group)operation time was 49.11±12.168 minutes,and group B(traction bed traditional steps)was 74.78±21.399 minutes,group C(lateral position of traction bed group)operation time was 55.17±15.170 minutes,surgery time of group A is better than that of group B,and after placement intramedullary pin and screw blade on the critical steps such as the operation time of group A is less than group B,the difference statistically significant(P<0.05).There was no significant difference between group A and Group C.3.Comparison of intraoperative c-arm application times:In group A(improved traction bed procedure group),the number of intraoperative fluoroscopy was 27.56±4.213,and the number of c-arm movement was 12.56±1.729.In group B(traction bed traditional step group),the number of fluoroscopy was 35.47±5.111,and the number of c-arm movement was 20.00±4.156.The fluoroscopy times of group C(side-lying non-traction bed group)were 39.37±7.275,and the c-arm movement times were 25.23±6.477.The c-arm application times of group A were better than those of group B and Group C,and the difference was statistically significant(P<0.05).4.Comparison of postoperative indicators:in terms of fracture healing time indicators,there was no significant difference between group A(traction bed step improvement group)and group B(traction bed traditional step group)(P>0.05).VAS scores on day 1,3 and 5 were 6.80±0.894,4.60±0.915 and 2.71±0.843 in group A and 7.40±0.915,4.80±0.869 and 3.00±0.853 in group B,respectively.The Harris scores of group A at 1,3,6,and 9 months after surgery were 82.13±2.676,86.56±2.221,90.33±2.132,93.47±2.106,respectively.The postoperative Harris scores of group C(side lying non-traction bed group)were 78.17±2.365,83.50±2.013,89.20±2.455 and 93.20±1.215,respectively.Comparison of VAS scores between group A and group B on the first day after surgery showed statistically significant difference(P<0.05),while other postoperative scores showed no statistically significant difference(P>0.05).Harris hip score at 1 month,3 months and 6 months in group C was lower than that in group A,and the difference was statistically significant(P<0.05)..Conclusion After the optimization an d improvement of the operation procedure of the traditional traction bed,the operation procedure of the traction bed can be simplified,the operation and anesthesia time can be shortened,and the number of C-arm fluoroscopy can be effectively reduced,which is conducive to the promotion and application in clinical practice. |
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