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

卷:

期数:

2022年06期

页码:

325-329

栏目:

髋部骨折

出版日期:

2022-12-05

文章信息/Info

Title:

Application of minimally invasive reduction with double-reverse traction repositor in elderly unstable femoral intertrochanteric fractures

作者:

曹发奇; 谢旭东; 胡益强; 周武; 刘梦非; 米博斌; 刘国辉

430022 武汉，华中科技大学同济医学院附属协和医院骨科

Author(s):

Cao Faqi1;  Xie Xudong1;  Hu Yiqiang1;  Zhou Wu1;  Liu Mengfei1;  Mi Bobin1;  Liu Guohui1.

1Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.

关键词:

股骨转子间骨折;  双反牵引器;  PFNA;  微创;  老年人

Keywords:

Femoral intertrochanteric fracture;  Double-reverse traction repositor;  PFNA;  Minimally invasive;  Aged

DOI:

10.3877/cma.j.issn.2096-0263.2022.06.002

文献标志码:

A

摘要:

目的 探讨双反牵引器微创复位联合股骨近端防旋髓内钉（PFNA）内固定治疗老年不稳定型股骨转子间骨折的疗效。方法 回顾性分析本院2018年11月至2020年11月期间47例股骨转子间不稳定型骨折的患者，双反牵引器微创复位组（双反牵引组）22例，常规牵引床复位组（常规牵引床组）25例，年龄60～87岁。按照AO骨折分型：31-A2.2型10例，31-A2.3型24例，31-A3.1型7例，31-A3.2型6例。记录患者的术中复位时间、手术时间、手术切口长度、术中出血量、骨折愈合时间、术后一年髋关节功能Harris评分和髋部骨折功能恢复量表（FRS）评分。结果 47例患者获得完整随访，随访时间12～20个月，平均（15.1±2.2）个月。两组平均术中复位时间[双反牵引器组：（30.1±7.6）min，常规牵引床组：（53.9±10.3）min]、平均手术时间[双反牵引器组：（87.7±17.7）min，常规牵引床组：（114.6±14.9）min]差异有统计学意义（均P＜0.0001）；平均切口长度[双反牵引器组：（6.1±1.0）cm，常规牵引床组：（6.0±0.6）cm]、平均术中出血量[双反牵引器组：（145.9±20.6），常规牵引床组：（141.7±16.7）ml]、平均骨折愈合时间[双反牵引器组：（13.9±1.9）周，常规牵引床组：（14.5±1.7）周]、平均术后一年髋关节Harris评分[双反牵引器组：（82.6±5.9）分，常规牵引床组：（84.6±6.1）分]、平均术后一年髋关节FRS评分[双反牵引器组：（85.2±5.4）分，常规牵引床组：（84.3±6.0）分]差异均无统计学意义。其中常规牵引床组1例患者术后发生了下肢肌间静脉血栓形成，其他病例术后和随访过程中无手术相关并发症。结论 双反牵引器微创复位联合PFNA内固定治疗老年不稳定型股骨转子间骨折，可有效缩短患者术中复位时间与手术时间。

Abstract:

Objective To investigate the effect of minimally invasive reduction with double-reverse traction repositor combined with proximal femoral anti-rotation intramedullary nail (PFNA) internal fixation in the treatment of elderly unstable femoral intertrochanteric fractures. Methods A retrospective analysis was performed on 47 patients with unstable intertrochanteric fractures in our hospital from November 2018 to November 2020. There were 22 patients in the minimally invasive reduction with double-reverse traction repositor group and 25 patients in the conventional traction table group ,with range 60 to 87 years. The AO classification of the fractures was as follows: 10 cases with type 31-A2.2, 24 cases with type 31-A2.3, 7 cases with type 31-A3.1, 6 cases with type 31-A3.2. The intraoperative reduction time, operation time, surgical incision length, intraoperative blood loss, fracture healing time, Harris score of hip joint function and functional recovery scale (FRS) score a year after operation were recorded. Results 47 patients were followed up for 12 to 20 months, mean (15.1±2.2) months. Both groups showed the average intraoperative reduction time of [(30.1±7.6) vs (53.9±10.3) min, P<0.0001], the average operation time of [(87.7±17.7) vs (114.6±14.9) min, P<0.0001], the average incision length of [(6.1±1.0) vs (6.0±0.6) cm, P=0.529], the mean intraoperative bleeding volume of [(145.9±20.6) vs (141.7±16.7) ml, P=0.448], the mean fracture healing time of [(13.9±1.9) vs (14.5±1.7) weeks, P=0.348], the mean hip Harris score a year after operation of [(82.6±5.9) vs (84.6±6.1), P=0.257], the mean hip FRS score a year after operation of [(85.2±5.4) vs (84.3±6.0), P=0.594]. Among them, a patient in the conventional traction table group experienced lower extremity intermuscular venous thrombosis after operation, and there were no surgery-related complications in other cases after operation and during follow-up. Conclusion Minimally invasive reduction with double-reverse traction repositor combined with PFNA internal fixation in the treatment of elderly unstable intertrochanteric fractures could effectively shorten the intraoperative reduction time and operation time.

备注/Memo

备注/Memo:

基金项目：?国家科技部重点研发计划（No.2018YFC2001502, 2018YFB1105705）

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更新日期/Last Update: 2023-01-04