顺势牵引微创治疗在下肢骨折中的应用

doi:10.3877/cma.j.issn.2096-0263.2018.06.001

目的

介绍顺势牵引微创治疗在下肢骨折中的应用，分析其复位技巧和闭合复位的成功率。

方法

回顾性分析2015年10月到2017年5月山东大学齐鲁医院青岛院区创伤骨科应用双反牵引微创治疗的58例下肢骨折患者。所有患者均采用张氏牵引复位器闭合复位治疗骨折，闭合复位成功后选择接骨板经皮置入或髓内钉内固定。采集闭合复位成功率、术后感染率、神经血管并发症、骨折愈合、功能恢复情况。

结果

53例患者获得随访，随访时间为7~24个月，平均（11±4）个月。在顺势双反牵引辅助下，所有骨干骨折闭合复位均获得成功，36例胫骨平台骨折有21例闭合复位成功，15例有关节面塌陷的骨折结合阶梯钻和顶棒复位成功。1例切口出现浅表感染，经换药后愈合，没有血管神经并发症发生，所有患者骨折获得愈合，无内植物松动断裂、复位丢失等并发症。53例患者功能恢复良好，52例患者恢复到伤前生活或工作状态，1例工伤患者未回到工作岗位。

结论

在下肢骨折的治疗中，顺势微创技术是一种简单迅速、创伤小、恢复快的治疗方式，值得临床推广。

关键词: 胫骨骨折, 股骨骨折, 微创外科手术, 顺势双反牵引复位器

Objective

To introduce the application of homeopathic minimally invasive treatment for the lower extremity fractures, and analyze the tips and successful rate.

Methods

From October 2015 to May 2017, 58 patients with lower extremity fractures admitted to the trauma center of Qilu Hospital of Shandong University (Qingdao) were included in this study. There were 38 males and 20 females with an average of (36±12) years. All patients were treated with homeopathic minimally invasive methods with the application of Zhang's bidirectional traction device and followed up regularly. The outcome was evaluated according to successful rate of closed reduction, wound infection, neurovascular complication, fracture union and functional recovery.

Results

53 patients were followed up with a mean duration of (11±4) months (range, 7-24 months). With the aid of Zhang's bidirectional traction device, all patients were obtained satisfactory closed reduction; 21 cases of 31 tibial plateau fractures achieved approximately anatomic reduction, other 15 cases with depressed articular fragments received closed minimally reduction and autograft. One superficial infection occurred and was finally healed with routine dressing changes, no neurovascular injury were found, all fracture healed, no cases showed implant broken or reduction loss. 53 patients obtained satisfactory functional outcome, all expect 1 restored pre-injury activity and work status.

Conclusions

Homeopathic minimally invasive treatment with Zhang's bidirectional traction device is a convenient and effective option for lower extremity fractures. It is simple, rapid, minimally invasive and rapid recovery that worthy of clinical promotion.

Key words: Tibial fractures, Femoral fractures, Minimally invasive surgical procedures, Homeopathic bidirectional-traction reduction device

图1~11 男性，22岁，胫骨平台骨折Ⅵ型。图1~2　术前X线片；图3~4　术前CT；图5~6　微创顶棒复位前后；图7　术中微创切口像；图8~9　术后X线片；图10~11　术后CT

图28~32 男性，82岁，右侧股骨远端骨折，10年前同侧粗隆间骨折动力髋螺钉（DHS）固定病史。图28~29　术前正侧位X线片；图30~31　双反牵引闭合复位后正侧位X线片；图32　微创切口像

图33~39 女性，55岁，右侧胫腓骨远端骨折，双反牵引微创接骨板内固定。图33~34　术前X线片；图35　安装双反牵引器；图36~37　微创切口像；图38~39　术后X线片正侧位

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摘要

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Homeopathic minimally invasive treatment in lower extremity fractures

模态框（Modal）标题

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Homeopathic minimally invasive treatment in lower extremity fractures