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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 ›› 2022, Vol. 08 ›› Issue (06) : 325 -329. doi: 10.3877/cma.j.issn.2096-0263.2022.06.002

髋部骨折

双反牵引器微创复位在老年不稳定型股骨转子间骨折的应用研究
曹发奇1, 谢旭东1, 胡益强1, 周武1, 刘梦非1, 米博斌1, 刘国辉1,†()   
  1. 1. 430022　武汉，华中科技大学同济医学院附属协和医院骨科
  • 收稿日期:2022-06-27 出版日期:2022-12-05
  • 通信作者: 刘国辉
  • 基金资助:
    国家科技部重点研发计划(No.2018YFC2001502, 2018YFB1105705)

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

Faqi Cao1, Xudong Xie1, Yiqiang Hu1, Wu Zhou1, Mengfei Liu1, Bobin Mi1, Guohui Liu1,†()   

  1. 1. Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
  • Received:2022-06-27 Published:2022-12-05
  • Corresponding author: Guohui Liu
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引用本文：

曹发奇, 谢旭东, 胡益强, 周武, 刘梦非, 米博斌, 刘国辉. 双反牵引器微创复位在老年不稳定型股骨转子间骨折的应用研究[J]. 中华老年骨科与康复电子杂志, 2022, 08(06): 325-329.

Faqi Cao, Xudong Xie, Yiqiang Hu, Wu Zhou, Mengfei Liu, Bobin Mi, Guohui Liu. Application of minimally invasive reduction with double-reverse traction repositor in elderly unstable femoral intertrochanteric fractures[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2022, 08(06): 325-329.

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。

关键词: 股骨转子间骨折, 双反牵引器, PFNA, 微创, 老年人
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.

Key words: Femoral intertrochanteric fracture, Double-reverse traction repositor, PFNA, Minimally invasive, Aged
图1 不稳定型股骨转子间骨折病例纳入流程图
表1 两组股骨转子间不稳定型骨折患者基本信息比较
组别 例数 性别（男/女，例） 年龄（岁， ±s ） 受伤原因（交通事故/高坠伤/跌倒伤，例） BMI（kg/m2， ±s ）
双反牵引器组 22 18/4 69.3±6.9 6/8/8 23.6±2.3
常规牵引床组 25 17/8 70.2±6.1 7/10/8 22.8±2.2
统计值   χ2=1.175 t=0.487 χ2=0.108 t=1.289
P值   0.278 0.629 0.947 0.204
表2 两组股骨转子间不稳定型骨折患者术中情况比较（±s）
组别 术中复位时间（min） 手术时间（min） 切口长度（cm） 术中出血量（ml）
双反牵引器组 30.1±7.6 87.7±17.7 6.1±1.0 145.9±20.6
常规牵引床组 53.9±10.3 114.6±14.9 6.0±0.6 141.7±16.7
t值 8.898 6.401 0.635 0.765
P值 <0.001 <0.001 0.529 0.448
图2~9 患者，女，87岁，右侧不稳定型股骨转子间骨折、糖尿病、缺血性心脏病，双反牵引器微创复位；股骨转子间骨折后PFNA内固定。图2术前X线图；图3双反牵引器侧位图；图4~6术中置入PFNA过程。图4置钉前；图5置钉后正位图；图6置钉后侧位图；图7术后切口图；图8~9术后X线图
表3 两组股骨转子间不稳定型骨折患者术后情况比较（±s）
组别 骨折愈合时间（周） Harris评分（分） FRS评分（分）
双反牵引器组 13.9±1.9 82.6±5.9 85.2±5.4
常规牵引床组 14.5±1.7 84.6±6.1 84.3±6.0
t值 0.949 1.148 0.289
P值 0.348 0.257 0.594
1
Weller I, Wai EK, Jaglal S, et al. The effect of hospital type and surgical delay on mortality after surgery for hip fracture [J]. J Bone Joint Surg Br, 2005, 87(3): 361-366.
2
Dhanwal DK, Dennison EM, Harvey NC. Epidemiology of hip fracture: Worldwide geographic variation [J]. Indian J Orthop, 2011, 45(1): 15-22.
3
Jiang X, Wang Y, Ma XL, et al. Proximal femoral nail antirotation versus reverse less invasive stabilization system-distal femur for treating proximal femoral fractures a meta-analysis [J]. Medicine (Baltimore), 2016, 95(14): e3168.
4
Šmejkal K, Lochman P, Trlica J, et al. [Impaired Healing after Surgery for Femoral Fractures] [J]. Acta Chir Orthop Traumatol Cech, 2015, 82(5):358-363.
5
Kempf I, Grosse A, Beck G. Closed locked intramedullary nailing. Its application to comminuted fractures of the femur [J]. J Bone Joint Surg Am, 1985, 67(5): 709-720.
6
Callanan I, Choudhry V, Smith H. Perineal sloughing as a result of pressure necrosis from the traction post during prolonged bilateral femoral nailing [J]. Injury, 1994, 25(7): 472.
7
Zhang R, Yin Y, Li S, et al. Traction table versus double reverse traction repositor in the treatment of femoral shaft fractures [J]. Sci Rep, 2018, 8(1): 5952.
8
周武,曹发奇,曾睿寅,等.创伤骨科患者围术期下肢静脉血栓形成诊断及防治专家共识(2022年) [J].中华创伤杂志, 2022, 38(1): 23-31.
9
Johnell O, Kanis JA. An estimate of the worldwide prevalence, mortality and disability associated with hip fracture [J]. Osteoporos Int, 2004, 15(11): 897-902.
10
Parker MJ, Bowers TR, Pryor GA. Sliding hip screw versus the Targon PF nail in the treatment of trochanteric fractures of the hip: a randomised trial of 600 fractures [J]. J Bone Joint Surg Br, 2012, 94B(3): 391-397.
11
Queally JM, Harris E, Handoll HH, et al. Intramedullary nails for extracapsular hip fractures in adults [J]. Cochrane Database Syst Rev, 2014 (9): CD004961.
12
Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults [J]. Cochrane Database Syst Rev, 2005 (4): CD000093.
13
Zhang Y, He W, Liu Y W, et al. [Comparison of the efftec between eccentric fixation and intramedullary fixation for treatment of intertrochanteric fractures][J]. Zhongguo Gu Shang, 2015, 28(2): 117-121.
14
Page PR, Lord R, Jawad A, et al. Changing trends in the management of intertrochanteric hip fractures - A single centre experience [J]. Injury-International Journal of the Care of the Injured, 2016, 47(7): 1525-1529.
15
Sahin S, Ertürer E, Oztürk I, et al. Radiographic and functional results of osteosynthesis using the proximal femoral nail antirotation (PFNA) in the treatment of unstable intertrochanteric femoral fractures [J]. Acta Orthop Traumatol Turc, 2010, 44(2): 127-134.
16
Lenich A, Mayr E, Rüter A, et al. First results with the trochanter fixation nail (TFN): a report on 120 cases [J]. Arch Orthop Trauma Surg, 2006, 126(10): 706-712.
17
17曲磊,李计东,李博,等.双向复位联合PFNA治疗股骨粗隆间骨折的初步临床应用[J].中华老年骨科与康复电子杂志, 2020, 02(6): 94-98.
18
刘涛,鲍飞龙,亢世杰,等.顺势牵引微创治疗在下肢骨折中的应用[J].中华老年骨科与康复电子杂志, 2018 (6): 321-326.
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