[1]丛锐军,仇荣敏,刘俊峰,等.顺势牵引复位技术治疗股骨干骨折的前瞻性随机对照临床试验[J].中华老年骨科与康复电子杂志,2018,(04):193-197.[doi:10.3877/cma.j.issn.2096-0263.2018.04.001]
　Cong Ruijun,Qiu Rongmin,Liu Junfeng,et al.Prospective randomized trial of homeopathic traction reduction technique for femoral shaft fracture[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2018,(04):193-197.[doi:10.3877/cma.j.issn.2096-0263.2018.04.001]
点击复制

顺势牵引复位技术治疗股骨干骨折的前瞻性随机对照临床试验()
分享到：

中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2018年04期
页码:
193-197
栏目:
股骨骨折
出版日期:
2018-07-30

文章信息/Info

Title:
Prospective  randomized  trial  of  homeopathic traction reduction technique for femoral shaft fracture
作者:
丛锐军1; 仇荣敏2; 刘俊峰1; 迪力夏提·多力坤1; 侯孝东1; 郑龙坡1
200072 上海市第十人民医院暨同济大学附属第十人民医院骨科1，麻醉科2
Author(s):
Cong Ruijun1;  Qiu Rongmin2;  Liu Junfeng1;  Dilixiati·Duolikun1;  Hou Xiaodong1;  Zheng Longpo1
1Department of Orthopedic, 2Department of Anesthesiology, Shanghai Tenth People’s Hospital, Tenth people’s Hospital of Tongji University, Shanghai 200072, China
关键词:
股骨骨折;  外科手术; 微创性;  牵引术;  顺势双反牵引复位器
Keywords:
Femoral fractures;  Suigical procedures;  minimally invasive;  Homeopathic bidirectional-tration reduction device
DOI:
10.3877/cma.j.issn.2096-0263.2018.04.001
文献标志码:
A
摘要:
目的 探索顺势牵引复位技术是否能为股骨髓内钉治疗股骨干骨折提供更好的牵引复位、提高手术效率并减少手术创伤。方法 前瞻性收集2016年1月至2017年9月同济大学附属上海市第十人民医院收治的行闭合或有限切开复位髓内钉固定术治疗的股骨干骨折60例。采用随机数法随机分为顺势牵引复位组和牵引床复位组，各30例。顺势牵引复位组采用顺势双反牵引复位器牵引复位，牵引床复位组使用牵引床辅助复位。观察指标包括：股骨正侧位X线片、VAS评分、SF-36评分、手术时间（麻醉完成至牵引拆除）、术中出血量、围手术期失血量、复位切口长度、股骨畸形程度。结果 60例患者均获得满意随访，随访率100%。顺势牵引复位组均实现闭合或有限切开复位，牵引床复位组26例实现闭合或有限切开复位，4例因无法复位延长切口纳入切开病例，顺势牵引复位组无切开，复位困难发生率低于牵引床复位组，差异有统计学意义（P=0.038）。顺势牵引复位组患者手术时间[（121±22）min]少于牵引床复位组[（147±31）min]，差异有统计学意义（t=3.746，P＜0.001）。顺势牵引复位组患者的术中出血量[（320±50）ml]少于牵引床复位组[（410±55）ml，t=6.632，P＜0.001]，围手术期失血量两组差异无统计学意义[（423±115）ml，（474±100）ml，t=1.833，P=0.073]。 结论 双反牵引复位技术能提供符合下肢力线的牵引方向，准确的牵引调整更方便复位和纠正旋转成角畸形，足够的牵引强度显著提高了复位效率与复位精确程度，减少术中失血，缩短手术时间，是值得推广的术中牵引复位技术。
Abstract:
Objective To explore whether the homeopathic traction reduction technique can provide better traction reduction for femoral shaft fractures with femoral intramedullary nailing, and improve the efficiency of surgery and reduce the surgical trauma. Methods Sixty cases of femoral shaft fractures treated by closed or limited open reduction and intramedullary nailing were prospectively collected from January 2016 to September 2017 in Shanghai Tenth People’s Hospital. They were divided into homeopathic traction group and traction table group randomly using computer random number method, 30 cases in each. The homeopathic traction group used the homeopathic double reverse traction device, while traction table group used a standard orthopaedic traction table. Obvervational index including the preoperative and postoperative X-ray, VAS score, SF-36 score, operation time, Intraoperative blood loss, perioperative blood loss and incision length, femoral deformity degree. Results All 60 cases received well follow-up and the rate was 100%. Homeopathic traction group all achieved closed or limited open reduction, 26 cases in traction table group receives closed or limited open reduction, 4 cases changed to open reduction, the incidence of difficult to reset in homeopathic traction group was lower than the traction table group, there was statistical significance (P=0.038). The operation time of the homeopathic traction group [(121±22)min] was shorter than that of the traction table group [(147±31)min, t=3.746, P<0.001]. The blood loss and perioperative blood loss in the homeopathic traction group [ (320±50)ml, (423±115)ml] were less than the traction table group [(410±55)ml, (474±100)ml, t=6.632, t=1.833, P<0.001, P=0.073). Conclusions Double reverse traction technique can provide traction direction parallel to lower limb alignment. More convenient and accurate to adjustment such as Varus-valgus angle and rotating angle. It also could provide enough traction strength, which could significantly improve the efficiency and accuracy of reduction. Double reverse traction technique can reduce the intraoperative blood loss, shorten the operation time, it is an excellent technology worth promotion.

参考文献/References:

1 Zhang YZ. Minimally invasive reduction and fixation in orthopedic trauma [J]. Chin Med J, 2016, 129(21): 2521-2523.
2 Muller M, Freude T, Stockle U, et al. [Intramedullary nailing in diaphyseal clavicle fractures using minimally invasive percutaneous reduction]. Oper Orthop Traumatol, 2017, 29(1): 97-102.
3 Chen W, Zhang T, Wang J, et al. Minimally invasive treatment of displaced femoral shaft fractures with a rapid reductor and intramedullary nail fixation [J]. Int Orthop, 2016, 40(1): 167-172.
4 常恒瑞, 郑占乐, 陈伟, 等. 双反牵引快速复位器微创治疗胫骨中下段骨折的初步临床应用 [J]. 河北医科大学学报, 2015, 36(12): 1470-1471.
5 郑占乐, 张飞, 何泽阳, 等. 双向牵引闭合复位微创治疗胫骨平台骨折的初步临床应用 [J]. 河北医科大学学报, 2015, 36(4): 491-492.
6 Pajarinen J, Lindahl J, Michelsson O, et al. Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail. A randomised study comparing post-operative rehabilitation [J]. J Bone Joint Surg Br 2005, 87(1): 76-81.
7 丛锐军, 刘伟, 吴海山, 等. 非手术因素对人工全膝关节置换术围手术期失血量的影响 [J]. 骨科, 2010, 1(3): 144-147.
8 He GC, Wang HS, Wang QF, et al. Effect of minimally invasive percutaneous plates versus interlocking intramedullary nailing in tibial shaft treatment for fractures in adults: a meta-analysis [J]. Clinics (Sao Paulo), 2014, 69(4): 234-240.
9 Eichinger JK, Balog TP, Grassbaugh JA. Intramedullary fixation of clavicle fractures: anatomy, indications, advantages, and disadvantages [J]. J Am Acad Orthop Surg, 2016, 24(7): 455-464.
10 Kim KC, Lee JK, Hwang DS, et al. Stabilizing subtrochanteric femoral fractures with an interlocked intramedullary nail using the ’Joystick’ technique [J]. Orthopedics, 2007, 30(9): 705-708.
11 陈伟, 魏宁, 杜晨光, 等. 顺势双反牵引复位和牵引床复位对手术治疗老年股骨转子间骨折疗效的影响 [J]. 中华创伤杂志, 2017, 33(4): 102-107.
12 Topliss CJ, Webb JM. Interface pressure produced by the traction post on a standard orthopaedic table [J]. Injury, 2001, 32(9): 689-691.
13 Carlson DA, Dobozi WR, Rabin S. Peroneal nerve palsy and compartment syndrome in bilateral femoral fractures [J]. Clin Orthop Relat Res, 1995 (320): 115-118.
14 Karaman O, Ayhan E, Kesmezacar H, et al. Rotational malalignment after closed intramedullary nailing of femoral shaft fractures and its influence on daily Life [J]. Eur J Orthop Surg Traumatol, 2014, 24(7): 1243-1247.
15 Ciftdemir M, Tuncel SA, Ozcan M, et al. Does electromagnetic-manual guided distal locking influence rotational alignment in antegrade femoral nailing? [J] Int Orthop, 2015, 39(3): 507-512.
16 Kulkarni SG, Babhulkar SS, Kulkarni SM, et al. Augmentation of intramedullary nailing in unstable intertrochanteric fractures using cerclage wire and lag screws: a comparative study [J]. Injury, 2017, 48 Suppl 2: S18-S22.
17 Lu B, Liu P, Wang Y, et al. [Case-traction table study on hidden blood loss in perioperative period of femoral intertrochanteric fractures in elderly patients treated with intramedullary nailing] [J]. Zhongguo gu shang, 2015, 28(11): 1032-1036.

相似文献/References:

[1]刘军,李计东,刘丽君,等.双反牵引复位经皮微创锁定接骨板内固定治疗股骨远端骨折的临床疗效[J].中华老年骨科与康复电子杂志,2017,(01):27.[doi:10.3877/cma.j.issn.2096-0263.2017.01.006]
　Liu Jun,Li Jidong,Liu Lijun,et al.The efficacy of double reverse traction combined with percutaneous minimally invasive locking plate internal fixation in treatement of distal femoral fractures[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(04):27.[doi:10.3877/cma.j.issn.2096-0263.2017.01.006]
[2]贾建波,禹宝庆,吴良浩,等.传统后路与微创 SuperPath入路的半髋置换治疗老年股骨颈骨折疗效比较[J].中华老年骨科与康复电子杂志,2017,(04):223.[doi:10.3877/cma.j.issn.2096-0263.2017.04.006]
　Jia Jianbo,Yu Baoqing,Wu Lianghao,et al.Hip hemiarthroplasty for senile femoral neck fractures: minimally invasive SuperPath approach versus traditional posterior approach[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(04):223.[doi:10.3877/cma.j.issn.2096-0263.2017.04.006]
[3]张超,王国文,韩秀鑫,等.肿瘤型假体置换治疗老年股骨上段转移瘤的疗效分析[J].中华老年骨科与康复电子杂志,2017,(06):332.[doi:10.3877/cma.j.issn.2096-0263.2017.06.003]
　Zhang Chao,Wang Guowen,Han Xiuxin,et al.The analysis of the surgical of tumor prosthetic replacement effect on treating elder patients with proximal femur metastasis[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(04):332.[doi:10.3877/cma.j.issn.2096-0263.2017.06.003]
[4]陆惠根,黄鑫,张中伟,等.肺癌脊柱转移瘤的手术疗效分析[J].中华老年骨科与康复电子杂志,2018,(01):14.[doi:10.3877/cma.j.issn.2096-0263.2018.01.004]
　Lu Huigen,Huang Xin,Zhang Zhongwei,et al.The curative effect of surgical treatment for spinal metastases of lung cancer[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2018,(04):14.[doi:10.3877/cma.j.issn.2096-0263.2018.01.004]
[5]迪力夏提·多力坤,郑龙坡.顺势复位治疗胫骨平台骨折的临床研究[J].中华老年骨科与康复电子杂志,2018,(03):163.[doi:10.3877/cma.j.issn.2096-0263.2018.03.008]
　Dilixiati Duolikun,Zheng Longpo.Clinical study of homeopathic bidirection-traction reduction device for tibial plateau fractures[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2018,(04):163.[doi:10.3877/cma.j.issn.2096-0263.2018.03.008]
[6]王昊 方诗元 王叙进 徐磊 杨家赵 李黎 刘雷.传统切开复位与顺势反向牵引复位微创固定治疗股骨远端骨折的临床比较[J].中华老年骨科与康复电子杂志,2018,(05):257.
　Wang Hao,Fang Shiyuan,Wang Xujin,et al. Clinical comparison between traditional open reduction and Zhang’s traction device for minimally invasive treatment of distal femoral fractures[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2018,(04):257.
[7]亢世杰 胡义明 鲍飞龙 黄东生 江涛 刘涛. 双反牵引、微创复位及raft技术治疗后内及后外侧胫骨平台骨折[J].中华老年骨科与康复电子杂志,2018,(05):261.
　Kang Shijie,Hu Yiming,Bao Feilong,et al.Posteromedial and posterolateral tibial plateau fractures after homeopathic double reverse traction, minimally invasive reduction and raft technique[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2018,(04):261.
[8]李伟,楼宇梁,全仁夫.脊柱后路PSO截骨长节段固定治疗 Kummells病伴脊柱后凸的临床疗效[J].中华老年骨科与康复电子杂志,2019,(01):33.[doi:10.3877/cma.j.issn.2096-0263.2019.01.007]
　Li Wei,Lou Yuliang,Quan Renfu.The treatment evaluation for osteoporotic Kummell disease with kyphosis by posterior spine osteotomy long segment fixation[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2019,(04):33.[doi:10.3877/cma.j.issn.2096-0263.2019.01.007]
[9]韩鹏飞 张芝良,陈成龙,陈韬予,等.机器人辅助椎弓根置钉治疗老年脊柱退行性疾病的Meta分析[J].中华老年骨科与康复电子杂志,2019,(01):39.[doi:10.3877/cma.j.issn.2096-0263.2019.01.008]
　Han Pengfei,Zhang Zhiliang,Chen Chenglong,et al.Robot-assisted placement of pedicle screws for treatment of spine degenerative diseases: A Meta-Analysis[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2019,(04):39.[doi:10.3877/cma.j.issn.2096-0263.2019.01.008]
[10]梁智林 臧传义 杨波 唐杰 赵小林 佟训哲 高茂龙.老年腰椎间盘突出症患者手术疗效的影响因素及对策[J].中华老年骨科与康复电子杂志,2019,(03):130.[doi:10.3877/cma.j.issn.2096-0263.2019.002]
　Liang Zhilin,Zang Chuanyi,Yang Bo,et al. Affecting factors and strategies of surgical treatment for elder people with lumbar disc herniation[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2019,(04):130.[doi:10.3877/cma.j.issn.2096-0263.2019.002]

备注/Memo

备注/Memo:
基金项目：国家重点研发计划课题（2017YFC0110603）
更新日期/Last Update: 2018-07-30