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

doi:10.3877/cma.j.issn.2096-0263.2022.06.002

Abstract

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.

Key words: Femoral intertrochanteric fracture, Double-reverse traction repositor, PFNA, Minimally invasive, Aged

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.

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References 18

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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

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

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

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

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

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