经骨皮质临时固定技术在股骨转子间骨折术中维持复位的可行性研究  

Feasibility study of Kirschner wire-fixation-cortical bone technique in treatment of intertrochanteric fracture

作　　者：田可为 刘超 严嘉祥 范克杰 马文龙 陈柯 TIAN Kewei;LIU Chao;YAN Jiaxiang;FAN Kejie;MA Wenlong;CHEN Ke(No.1 Department of Hip Injury and Disease,Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital),Luoyang Henan,471000,P.R.China;Department of Pelvic Injury and Disease,Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital),Luoyang Henan,471000,P.R.China;Department of Geriatric Disease,Luoyang No.1 Hospital of Traditional Chinese Medicine,Luoyang Henan,471000,P.R.China)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院)髋部损伤一科,河南洛阳471000 [2]河南省洛阳正骨医院(河南省骨科医院)骨盆髋臼科,河南洛阳471000 [3]河南省洛阳市第一中医院老年病科,河南洛阳471000

出　　处：《中国修复重建外科杂志》2019年第10期1239-1244,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：河南省中医药科学研究专项课题(2018ZY2160)~~

摘　　要：目的探讨经骨皮质临时固定技术在不稳定型顺向股骨转子间骨折术中维持复位的可行性及有效性。方法选取2015年5月-2017年1月收治的符合国际内固定研究协会/美国骨创伤协会(AO/OTA)31-A2.2型股骨转子间骨折,且需行闭合复位股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)治疗的患者40例,随机分为试验组(术中使用经骨皮质临时固定技术组,20例)和对照组(常规治疗组,20例)。两组患者性别、年龄、侧别、体质量指数、致伤原因、受伤至手术时间等一般资料比较差异无统计学意义(P>0.05)。记录两组患者手术时间、术中出血量、术中透视次数;根据张世民等提出的术中透视内侧与前侧皮质对应关系(正性、中性、负性支撑)来判断骨折复位质量,观察内固定稳定及骨折愈合情况;术后12个月采用Harris评分评价患髋关节功能恢复情况。结果试验组术中2枚克氏针共植入次数≤4次6例(30%),5~8次7例(35%),≥9次7例(35%)。两组患者手术时间及术中出血量比较差异无统计学意义(P>0.05),但试验组输血量及术中透视次数均显著少于对照组(P<0.05)。两组患者均获随访,随访时间13~21个月,平均17个月。术后无切口感染、下肢深静脉血栓形成、再骨折等并发症以及内固定相关并发症发生。试验组术中复位质量显著优于对照组(Z=–2.794,P=0.024)。术后12个月试验组Harris评分显著优于对照组,差异有统计学意义(t=2.98,P=0.01)。结论股骨转子间骨折闭合复位PFNA内固定术中使用经骨皮质临时固定技术,可在术中有效维持复位效果,减少术者透视次数,提高复位质量,减少异体血输入,获得更好的髋关节功能,且不增加手术时间和术中出血量。Objective To explore the feasibility and effectiveness of maintaining the reduction of unstable intertrochanteric fractures by Kirschner wire-fixation-cortical bone technique. Methods Forty patients with intertrochanteric fracture [AO/Orthopaedic Trauma Association(AO/OTA) type 31-A2.2] admitted between May 2015 and January 2017 and requiring closed reduction and proximal femoral nail antirotation(PFNA) were randomly divided into trial group(intraoperative Kirschner wire-fixation-cortical bone technique group, 20 cases) and control group(conventional treatment group, 20 cases). There was no significant difference in general data of gender, age, side, body mass index, cause of injury, time from injury to operation between the two groups(P>0.05). The operation time,intraoperative blood loss, and intraoperative fluoroscopy times of the two groups were recorded;the reduction quality of fracture was observed according to the corresponding relationship between medial and anterior cortex(positive, neutral,and negative support) of intraoperative fluoroscopy proposed by ZHANG Shimin, and the stability of internal fixation and fracture healing were observed;Harris score was used to evaluate the recovery of hip function at 12 months after operation. Results In the trial group, 6 cases(30%) had 2 Kirschner wires implanted less than 4 times, 7 cases(35%) had5-8 times, and 7 cases(35%) had 9 times or more. There was no significant difference in operation time and intraoperative blood loss between the two groups(P>0.05), but the blood transfusion volume and intraoperative fluoroscopy times in the trial group were significantly less than those in the control group(P<0.05). Both groups were followed up 13-21 months,with an average of 17 months. There was no complications such as wound infection, deep venous thrombosis of lower extremities, refracture, and internal fixation-related complications. The quality of intraoperative reduction in the trial group was significantly better than that in the control group(Z=–2.794, P=0.024).

关 键 词：经骨皮质临时固定技术 股骨转子间骨折 微创 闭合复位 

分 类 号：R687.3[医药卫生—骨科学]