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

doi:10.3877/cma.j.issn.2096-0263.2021.06.002

Abstract

Abstract:

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

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.

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References 21

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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）
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）	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

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）
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）	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

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

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

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

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