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中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2021, Vol. 07 ›› Issue (06) : 326 -332. doi: 10.3877/cma.j.issn.2096-0263.2021.06.002

股骨骨折

经皮双改锥微创与切开复位治疗难复性股骨粗隆间骨折的比较
马腾1, 黄强1,†(), 许毅博1, 路遥1, 薛汉中1, 李忠1, 张堃1   
  1. 1. 710054　西安交通大学附属红会医院创伤骨科下肢病区
  • 收稿日期:2021-07-31 出版日期:2021-12-05
  • 通信作者: 黄强
  • 基金资助:
    国家自然科学基金青年项目(81600700); 陕西省重点研发计划一般项目-社会发展领域(2021SF-243)

Comparative study of percutaneous double screwdriver minimally invasive reduction and limited open reduction in the treatment of irreducible femoral intertrochanteric fractures

Teng Ma1, Qiang Huang1,†(), Yibo Xu1, Yao Lu1, Hanzhong Xue1, Zhong Li1, Kun Zhang1   

  1. 1. Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an 710054, China
  • Received:2021-07-31 Published:2021-12-05
  • Corresponding author: Qiang Huang
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马腾, 黄强, 许毅博, 路遥, 薛汉中, 李忠, 张堃. 经皮双改锥微创与切开复位治疗难复性股骨粗隆间骨折的比较[J]. 中华老年骨科与康复电子杂志, 2021, 07(06): 326-332.

Teng Ma, Qiang Huang, Yibo Xu, Yao Lu, Hanzhong Xue, Zhong Li, Kun Zhang. Comparative study of percutaneous double screwdriver minimally invasive reduction and limited open reduction in the treatment of irreducible femoral intertrochanteric fractures[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2021, 07(06): 326-332.

目的

本研究旨在比较经皮双改锥微创复位与有限切开复位治疗难复性股骨粗隆间骨折的临床疗效。

方法

回顾性收集2016年1月至2018年1月西安市红会医院创伤骨科下肢病区共收治145例难复性股骨粗隆间骨折患者，获得完整随访的患者共128例，其中66例接受经皮双改锥微创复位（A组），另外62例接受有限切开复位（B组）治疗。所有骨折患者均按Evans-Jensen进行分型，均采用股骨近端抗旋髓内钉（PFNA）进行固定。观察手术指标，包括切口长度、出血量、术中透视次数和手术时间。所有患者随访至少一年。统计骨折愈合情况、并发症及髋关节Harris评分。

结果

128例患者获得完整随访，随访时间（19±4）个月。男性58例，女性70例，平均年龄（66±14）岁。A组和B组切口长度分别为（8.4±1.4）cm和（15.3±3.0）cm；出血量分别为（151±26）ml和（319±33）ml；术中透视次数分别为（14.1±2.9）次和（8.2±1.7）次；手术时间分别为（44±9）min和（73±11）min；骨折愈合时间分别为（55±12）d和（80±13）d。术后1年，A组和B组Harris评分分别为（86±4）分和（82±4）分；Harris评分优良率分别为92.4%和88.7%。经皮双改锥微创复位组切口长度更小，出血量更少，骨折愈合时间更短，Harris评分更高（P<0.05）。

结论

经皮双改锥微创复位技术在处理难复性股骨粗隆间骨折患者时，优于有限切开复位术。其可作为难复性股骨粗隆间骨折的首选复位方法，值得临床广泛推广。

关键词: 髋骨折, 微创, 复位
Objective

The purpose of this study was to compare the clinical effects of percutaneous double screwdriver minimally invasive reduction and limited open reduction in the treatment of irreducible femoral intertrochanteric fractures.

Methods

From January 2016 to January 2018, a total of 145 patients with irreducible femoral intertrochanteric fractures were treated in Xi'an Honghui hospital. 128 patients received complete follow-up, of which 66 received percutaneous double screwdriver minimally invasive reduction (Group A) and 62 received limited open reduction (Group B) treatment. All patients were classified according to Evans-Jensen classification and fixed with proximal femoral nail anti-rotation (PFNA). The operation indexes were observed, including incision length, bleeding volume, intraoperative fluoroscopy times and operation time. All patients were followed up for at least one year. The bone healing, complications and Harris score of hip joint were counted.

Results

128 patients were completely followed up. The mean follow-up time was (19±4) months. There were 58 males and 70 females, with an average age of (66±14) years. The incision length of Group A and B were (8.4±1.4) cm and (15.3±3.0) cm, respectively. The bleeding volume was (151 ± 26) ml and (319 ± 33) ml. The times of intraoperative fluoroscopy were (14.1±2.9) and (8.2±1.7). The operation time was (44±9) min and (73±11) min, respectively. The fracture healing time was (55±12)d and (80±13)d. One year after operation, the Harris scores of Group A and B were (86 ± 4) and (82 ± 4), respectively. The excellent and good rates of Harris score were 92.4% and 88.7%. Percutaneous double screwdriver minimally invasive reduction group had shorter incision length, less bleeding, shorter fracture healing time and higher Harris score (P<0.05).

Conclusions

The clinical effects of percutaneous double screwdriver minimally invasive reduction group was better than that of limited open reduction group. Percutaneous double screwdriver minimally invasive reduction technique can be used as the first choice for the reduction of irreducible femoral intertrochanteric fractures. It is worthy of clinical promotion.

Key words: Hip fractures, Minimally invasive, Reduction
表1 难复性股骨粗隆间骨折患者基本统计学信息
组别 例数 性别（例，男/女） 年龄（岁，±s） 体重指数（kg/m2，±s） 术前合并症（例） Evans-Jensen分型（例）
Ⅱ Ⅲ Ⅳ Ⅴ
A组 66 30/36 68±16 23±4 33 5 20 22 19
B组 62 28/34 66±12 24±3 30 3 16 23 20
t或χ2值     0.446 1.882 0.033 0.075 0.320 0.199 0.182
P值     0.656 0.062 0.855 0.784 0.572 0.656 0.670
图1~11 女性，63岁，难复性股骨粗隆间骨折患者，术中通过经皮双改锥微创复位获得满意复位。图1~2术前经多次闭合复位后，骨折端仍明显错位；图3~7透视下，采用经皮双改锥微创复位技术辅助复位，并获得满意复位；图8~9术后X线片示复位固定满意；图10~11术后1年，骨折愈合良好
表2 两组难复性股骨粗隆间骨折的手术指标比较
组别 例数 切口长度（cm，±s） 术中出血量（ml，±s） 引流量（ml，±s） 透视次数（次，±s） 手术时间（min，±s）
A组 66 8.4±1.4 151±26 33±14 14.1±2.9 44±9
B组 62 15.3±3.0 319±33 85±20 8.2±1.7 73±11
t值   16.501 31.518 16.992 14.143 16.106
P值   <0.05 <0.05 <0.05 <0.05 <0.05
表3 两组难复性股骨粗隆间骨折患者的临床效果比较
组别 例数 骨折初步愈合时间（d，±s） 骨不连[例（%）] 术后一年Harris评分（分，±s） Harris评分的优良率
A组 66 55±12 0（0.0） 86±4 61/66（92.4%）
B组 62 80±13 2（3.2） 82±4 55/62（88.7%）
t或χ2值   11.327 0.574 5.116 0.519
P值   0.001 0.449 0.001 0.471
表4 两组难复性股骨粗隆间骨折患者术后并发症比较[例（%）]
组别 例数 切口感染 褥疮 肺部感染 深静脉血栓
A组 66 0（0.0） 1（1.5） 3（4.5） 3（4.5）
B组 62 2（3.2） 5（8.1） 6（9.7） 5（8.1）
χ2值   0.574 1.778 0.623 0.209
P值   0.449 0.182 0.430 0.648
1
Lizaur-Utrilla A, Gonzalez-Navarro B, Vizcaya-Moreno MF, et al. Reasons for delaying surgery following hip fractures and its impact on one year mortality [J]. Int Orthop, 2019, 43(2): 441-448.
2
Chen J, Ma JX, Wang Y, et al. Correction to: finite element analysis of two cephalomedullary nails in treatment of elderly reverse obliquity intertrochanteric fractures: zimmer natural nail and proximal femoral nail antirotation-ΙΙ [J]. J Orthop Surg Res, 2020, 15(1): 98.
3
Min BW, Lee KJ, Oh JK, et al. The treatment strategies for failed fixation of intertrochanteric fractures [J]. Injury, 2019, 50(7): 1339-1346.
4
Maroun G, Chaftari R, Chokr J, et al. High comorbidity index is not associated with high morbidity and mortality when employing constrained arthroplasty as a primary treatment for intertrochanteric fractures in elderly patients [J]. Eur J Orthop Surg Traumatol, 2019, 29(5): 1009-1015.
5
Lorich DG, Geller DS, Nielson JH. Osteoporotic pertrochanteric hip fractures: management and current controversies [J]. Instr Course Lect, 2004, 53: 441-454.
6
Carr JB. The anterior and medial reduction of intertrochanteric fractures: a simple method to obtain a stable reduction [J]. J Orthop Trauma, 2007, 21(7): 485-489.
7
Makki D, Matar HE, Jacob N, et al. Comparison of the Reconstruction trochanteric antigrade nail (TAN) with the proximal femoral nail antirotation (PFNA) in the management of reverse oblique intertrochanteric hip fractures [J]. Injury, 2015, 46(12): 2389-2393.
8
Wang Q, Yang X, He HZ, et al. Comparative study of InterTAN and Dynamic Hip Screw in treatment of femoral intertrochanteric injury and wound [J]. Int J Clin Exp Med, 2014, 7(12): 5578-5582.
9
Manson TT. Open reduction and internal fixation plus total hip arthroplasty for the acute treatment of older patients with acetabular fracture: surgical techniques [J]. Orthop Clin North Am, 2020, 51(1): 13-26.
10
Magill H, Hajibandeh S, Bennett J, et al. Open reduction and internal fixation versus primary arthrodesis for the treatment of acute lisfranc injuries: a systematic review and meta-analysis [J]. J Foot Ankle Surg, 2019, 58(2): 328-332.
11
Jensen JS, Michaelsen M. Trochanteric femoral fractures treated with McLaughlin osteosynthesis [J]. Acta Orthop Scand, 1975, 46(5): 795-803.
12
Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation [J]. J Bone Joint Surg Am, 1969, 51(4): 737-755.
13
Zhu Y, Liu S, Chen W, et al. Epidemiology of low-energy lower extremity fracture in Chinese populations aged 50 years and above [J]. PLoS One, 2019, 14(1): e0209203.
14
Luo X, He S, Zeng D, et al. Proximal femoral nail antirotation versus hemiarthroplasty in the treatment of senile intertrochanteric fractures: Case report [J]. Int J Surg Case Rep, 2017, 38(1): 37-42.
15
姬晨妮，陈伟，朱燕宾,等.京津唐地区1583例老年股骨转子间骨折流行病学特征分析 [J/CD].中华老年骨科与康复电子杂志, 2015, 1(1): 45-49.
16
陈光伟. PFNA治疗老年股骨粗隆间骨折的疗效及安全性分析 [J].中华老年骨科与康复电子杂志, 2020, 6(3): 142-147.
17
Chun YS, Oh H, Cho YJ, et al. Technique and early results of percutaneous reduction of sagittally unstable intertrochateric fractures [J]. Clin Orthop Surg, 2011, 3(3): 217-224.
18
Kim Y, Dheep K, Lee J, et al. Hook leverage technique for reduction of intertrochanteric fracture [J]. Injury, 2014, 45(6): 1006-1010.
19
王建华，林艳，吴永东,等.经皮撬拨复位内固定技术对难复性股骨粗隆间骨折老年患者NE、AngⅡ水平及髋关节功能的影响 [J].中华老年骨科与康复电子杂志, 2021, 7(1): 9-14.
20
Burnei C, Popescu G, Barbu D, et al. Intramedullary osteosynthesis versus plate osteosynthesis in subtrochanteric fractures [J]. J Med Life, 2011, 4(4): 324-329.
21
Tsuji H, Takigawa T, Misawa H, et al. Minimally invasive percutaneous spinopelvic fixation for unstable pelvic ring fracture performed with the patient in a lateral position [J]. Clin Spine Surg, 2019, 32(5): 191-197.
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