牵抖收展复位结合InterTan髓内钉内固定治疗A2型老年股骨转子间骨折  

Traction-shaking-adduction-abduction reduction manipulation combined with InterTan intramedullary nail internal fixation for treatment of type A2 femoral intertrochanteric fractures in the aged

作　　者：朱佳福[1] 徐卫星[1] 吴震[1] 刘宏[1] ZHU Jiafu;XU Weixing;WU Zhen;LIU Hong(Tongde Hospital of Zhejiang Province,Hangzhou 310012,Zhejiang,China)

机构地区：[1]浙江省立同德医院,浙江杭州310012

出　　处：《中医正骨》2020年第2期19-22,29,共5页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：浙江省医药卫生科技计划项目(2019KY342)。

摘　　要：目的:观察牵抖收展复位结合InterTan髓内钉内固定治疗A2型老年股骨转子间骨折的临床疗效及安全性。方法:回顾性分析接受InterTan髓内钉内固定治疗的62例A2型老年股骨转子间骨折患者的病例资料,其中采用牵抖收展复位41例、传统牵引床复位21例。男39例,女23例。年龄65~93岁,中位数82岁。A2.1型骨折51例、A2.2型骨折9例、A2.3型骨折2例。受伤至手术时间3~7 d,中位数4 d。比较2组患者的复位透视次数、手术出血量(术前1 d与术后1 d血红蛋白的差值)、骨折愈合时间及Harris髋关节评分(包括疼痛、关节功能、关节畸形、活动度4项),术后随访观察并发症发生情况。结果:2组患者手术切口均甲级愈合。所有患者均获随访,随访时间9~26个月,中位数13个月。与传统复位组相比,牵抖收展复位组的复位透视次数少[(3.9±0.6)次,(6.2±1.9)次,t=0.262,P=0.029]、手术出血量小[(26.3±1.2)g·L^-1,(32.5±2.6)g·L^-1,t=0.839,P=0.016],但2组的骨折愈合时间差异无统计学意义[(4.3±0.2)月,(4.6±0.1)月,t=4.159,P=0.081]。牵抖收展复位组1例术后出现夜间谵妄、1例因低蛋白血症出现大量胸腔积液,均经治疗后好转。传统复位组2例因低蛋白血症出现大量胸腔积液,经治疗后好转。末次随访时,2组患者Harris髋关节评分中的疼痛、关节功能、关节畸形、活动度及总分比较,组间差异均无统计学意义[(42.1±1.1)分,(41.3±1.7)分,t=4.013,P=0.706;(43.3±1.7)分,(42.8±1.2)分,t=0.225,P=0.063;(3.8±0.1)分,(3.5±0.3)分,t=1.452,P=0.071;(4.4±0.3)分,(4.2±0.2)分,t=1.426,P=0.068;(93.7±2.5)分,(91.3±1.7)分,t=2.923,P=0.087]。结论:牵抖收展复位结合InterTan髓内钉内固定治疗A2型老年股骨转子间骨折,安全性高,与传统牵引床复位InterTan髓内钉内固定的综合疗效相当,但复位透视次数少、手术出血量小。Objective:To observe the clinical curative effects and safety of traction-shaking-adduction-abduction reduction manipulation combined with InterTan intramedullary nail internal fixation for treatment of type A2 femoral intertrochanteric fractures in the aged.Methods:The medical records of 62 aged patients with type A2 femoral intertrochanteric fractures who were treated with InterTan intramedullary nail internal fixation were analyzed retrospectively.Forty-one patients were treated with traction-shaking-adduction-abduction reduction manipulation(group A),and the others were treated with conventional traction bed-assisted reduction(group B).The patients consisted of 39 males and 23 females,and ranged in age from 65 to 93 years(Median=82 yrs)and in disease course from 3 to 7 days(Median=4 days).According to classification of fracture,the fractures belonged to types A2.1(51),A2.2(9)and A2.3(2).The frequency of X-ray exposure,blood loss(the hemoglobin differences between preoperative day 1 and postoperative day 1),fracture healing time and Harris hip scores(pain,joint function,joint deformity and range of motion(ROM))were compared between the 2 groups.The patients were followed up and the complication incidences were observed and compared between the 2 groups after the surgery.Results:All patients in the 2 groups got primary healing in the surgical incisions and all patients in the 2 groups were followed up for 9-26 months with a median of 13 months.The X-ray exposure was fewer and the blood loss was less in group A compared to group B(3.9+/-0.6 vs 6.2+/-1.9 times,t=0.262,P=0.029;26.3+/-1.2 vs 32.5+/-2.6 g/L,t=0.839,P=0.016),while there was no statistical difference in fracture healing time between the 2 groups(4.3+/-0.2 vs 4.6+/-0.1 months,t=4.159,P=0.081).The nocturnal delirium(1)was found in group A after operation,and the patient improved after treatment.The massive pleural effusion caused by hypoproteinemia were found in 1 patient in group A and 2 patients in group B,and the patients improved after treatment.The

关 键 词：髋骨折 转子间骨折 骨牵引复位法 骨折固定术 髓内 老年人 

分 类 号：R687.3[医药卫生—骨科学]