顺势牵引复位技术治疗股骨干骨折的前瞻性随机对照临床试验  

Prospective randomized trial of homeopathic traction reduction technique for femoral shaft fracture

作　　者：丛锐军[1] 仇荣敏 刘俊峰 迪力夏提.多力坤 侯孝东 郑龙坡[1] Cong Ruijun;Qiu Rongmin;Liu Junfeng;Dilixiati Duolikun;Hou Xiaodong;Zheng Longpo(Depart- ment of Orthopedic;Department of Anesthesiology,Shanghai Tenth People＇s Hospital,Tenth people＇s Hospi- tal of Tongji University,Shanghai 200072,China)

机构地区：[1]上海市第十人民医院暨同济大学附属第十人民医院骨科,200072 [2]上海市第十人民医院暨同济大学附属第十人民医院麻醉科,200072

出　　处：《中华老年骨科与康复电子杂志》2018年第4期193-197,共5页Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)

基　　金：国家重点研发计划课题(2017YFC0110603)

摘　　要：目的探索顺势牵引复位技术是否能为股骨髓内钉治疗股骨干骨折提供更好的牵引复位、提高手术效率并减少手术创伤。方法前瞻性收集2016年1月至2017年9月同济大学附属上海市第十人民医院收治的行闭合或有限切开复位髓内钉固定术治疗的股骨干骨折60例。采用电脑随机数法随机分为顺势牵引复位组和牵引床复位组,各30例。顺势牵引复位组采用顺势双反牵引复位器牵引复位,牵引床复位组使用牵引床辅助复位。观察指标包括:股骨正侧位X线片、VAS评分、SF-36评分、手术时间(麻醉完成至牵引拆除)、术中出血量、围手术期失血量、复位切口长度、股骨畸形程度。结果 60例患者均获得满意随访,随访率100%。顺势牵引复位组均实现闭合或有限切开复位,牵引床复位组26例实现闭合或有限切开复位,4例因无法复位延长切口纳入切开病例,顺势牵引复位组无切开,复位困难发生率低于牵引床复位组,差异有统计学意义(X^2=4.286,P=0.038)。顺势牵引复位组患者手术时间[(121±22)min]少于牵引床复位组[(147±31)min],差异有统计学意义(t=3.746,P<0.001)。顺势牵引复位组患者的术中出血量[(320±50)ml]少于牵引床复位组[(410±55)ml,t=6.632,P<0.001],围手术期失血量两组差异无统计学意义[(423±115)ml,(474±100)ml,t=1.833,P=0.073]。结论双反牵引复位技术能提供符合下肢力线的牵引方向,准确的牵引调整更方便复位和纠正旋转成角畸形,足够的牵引强度显著提高了复位效率与复位精确程度,减少术中失血,缩短手术时间,是值得推广的术中牵引复位技术。Objective To explore whether the homeopathic traction reduction technique can provide better traction reduction for femoral shaft fractures with femoral intramedullary nailing, and improve the efficiency of surgery and reduce the surgical trauma. Methods Sixty cases of femoral shaft fractures treated by closed or limited open reduction and intramedullary nailing were prospectively collected from January 2016 to September 2017 in Shanghai Tenth People＇s Hospital. They were divided into homeopathic traction group and traction table group randomly using computer random number method, 30 cases in each. The homeopathic traction group used the homeopathic double reverse traction device, while traction table group used a standard orthopaedic traction table. Obvervational index including the preoperative and postoperative X-ray, VAS score, SF-36 score, operation time, Intraoperative blood loss, perioperative blood loss and incision length, femoral deformity degree. Results All 60 cases received well follow-up and the rate was 100%. Homeopathic traction group all achieved closed or limited open reduction, 26 cases in traction table group receives closed or limited open reduction, 4 cases changed to open reduction, the incidence of difficult to reset in homeopathic traction group was lower than the traction table group, there was statistical significance（X^2=4.286, P=0.038）. The operation time of the homeopathic traction group [（121±22）min] was shorter than that of the traction table group [（147±31）min, t=3.746, P〈0.001]. The blood loss and perioperative blood loss in the homeopathic traction group [（320 ± 50）ml,（423 ± 115）ml] were less than the traction table group[（410 ± 55）ml,（474 ± 100）ml, t=6.632, t=1.833, P〈0.001, P=0.073）. Conclusions Double reverse traction technique can provide traction direction parallel to lower limb alignment. More convenient and accurate to adjustment such as Varus-valgus angle and rotating angle. It also could provide enough traction strength, which c

关 键 词：股骨骨折 外科手术 微创性 牵引术 顺势双反牵引复位器 

分 类 号：R687.3[医药卫生—骨科学]