股骨转子间骨折术前有无骨牵引对手术治疗的影响研究  

Influence on surgical treatment of intertrochanteric fracture with or without preoperative skeletal traction

作　　者：褚楷 王蕾[2] 陈旭[1] 张兴林[1] 鲁兴[1] 左海宁[1] 周智勇[1] 贾培桐 刘绍贤[1] 曲高伟[1] 

机构地区：[1]烟台市烟台山医院骨科,264000 [2]上海交通大学医学院附属瑞金医院骨科,200025

出　　处：《中华关节外科杂志（电子版）》2015年第4期13-17,共5页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的明确新鲜股骨转子间骨折的患者术前是否需要骨牵引治疗。方法回顾分析本组自2012年6月至2013年6月受伤7 d内行股骨转子间骨折闭合复位股骨近端防旋型髓内钉（PFNA）内固定手术治疗的患者82例,将患者分为术前骨牵引组与术前无骨牵引组两组。骨牵引治疗39例,其中男19例,女20例,患者平均年龄（67±9）岁。无骨牵引治疗43例,其中男20例,女23例,患者平均年龄（65±6）岁。比较两组患者术前疼痛评分、术中复位所用的时间、围手术期总失血量、围手术期并发症发生率、术后患者完全下地的负重时间、骨折愈合时间及最终患肢髋关节评分的情况。结果对两组82例患者均进行了8~16个月（平均12.5个月）的回访。骨牵引组患者术前疼痛评分（5.7±1.3）分、手术中复位所用的时间（26.1±6.1）min及围手术期总体失血量（1053.3±143.5）ml与无骨牵引组患者术前疼痛评分（6.3±1.4）分、手术中复位所用的时间（24.1±3.9）min及围手术期总体失血量（1035.7±116.8）ml比较,差异均无统计学意义（P〉0.05）。围手术期并发症的发生频率、术后患者完全下地负重的时间、骨折的愈合时间及最终患肢髋关节评分分别进行统计分析对比,结果显示两组患者在这几个方面对比分析没有统计学差异（P〉0.05）。结论对于新鲜股骨转子间骨折手术治疗的患者,术前骨牵引不是必须的治疗。Objective To discuss whether the preoperative skeletal traction is necessary for the patients with fresh intertrochanteric fracture. Methods Eighty-two patients of intertrochanteric fracture within seven days after the injury in our hospital treated by proximal femoral nail anti-rotation（ PFNA）operation from August 2012 to August 2013 were reviewed. The patients were divided into the traction group and the non-traction group. The traction group included 39 patients of 19 males and 20 females,the average age was（ 67 ± 9） years. The non-traction group included 43 patients of 20 males and 23 females,the average age was（ 65. 0 ± 6. 3） years. The patients in the traction group adopted preoperative skeletal traction. The preoperative pain score,time of reduction in the operation,the perioperative total blood loss,the incidence of perioperative complications,time of weight-bearing walk,time of the fracture healing and Harris hip scores were compared. Results The average follow-up time was 12. 5 months（ 8-16 months）for both the two groups. No significant difference was found between the two groups in the preoperative pain score[the traction group：（ 5. 7 ± 1. 3）,the non-traction group：（ 6. 3 ± 1. 4） ],time of reduction in operation[the traction group：（ 26. 1 ± 6. 1） min,the non-traction group：（ 24. 1 ± 3. 9） min],and the perioperative total blood loss[the traction group：（ 1053. 3 ± 143. 5） ml,the non-traction group：（ 1035. 7 ±116. 8） ml]. No significant difference was found between the two groups in the incidence of perioperative complications,the time of weight-bearing walk,the fracture healing time or Harris score. Conclusion Preoperative skeletal traction is not necessary for the patients with fresh intertrochanteric fracture.

关 键 词：髋骨折 骨牵引复位法 骨折固定术 内 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]