经皮双改锥微创与切开复位治疗难复性股骨粗隆间骨折的比较  

Comparative study of percutaneous double screwdriver minimally invasive reduction and limited open reduction in the treatment of irreducible femoral intertrochanteric fractures

作　　者：马腾[1] 黄强[1] 许毅博 路遥[1] 薛汉中[1] 李忠[1] 张堃[1] Ma Teng;Huang Qiang;Xu Yibo;Lu Yao;Xue Hanzhong;Li Zhong;Zhang Kun(Department of Orthopedic Surgery,Hong Hui Hospital,Xi'an Jiaotong University,Xi'an 710054,China)

机构地区：[1]西安交通大学附属红会医院创伤骨科下肢病区,710054

出　　处：《中华老年骨科与康复电子杂志》2021年第6期326-332,共7页Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)

基　　金：国家自然科学基金青年项目(81600700);陕西省重点研发计划一般项目-社会发展领域(2021SF-243)。

摘　　要：目的本研究旨在比较经皮双改锥微创复位与有限切开复位治疗难复性股骨粗隆间骨折的临床疗效。方法回顾性收集2016年1月至2018年1月西安市红会医院创伤骨科下肢病区共收治145例难复性股骨粗隆间骨折患者,获得完整随访的患者共128例,其中66例接受经皮双改锥微创复位(A组),另外62例接受有限切开复位(B组)治疗。所有骨折患者均按Evans-Jensen进行分型,均采用股骨近端抗旋髓内钉(PFNA)进行固定。观察手术指标,包括切口长度、出血量、术中透视次数和手术时间。所有患者随访至少一年。统计骨折愈合情况、并发症及髋关节Harris评分。结果128例患者获得完整随访,随访时间(19±4)个月。男性58例,女性70例,平均年龄(66±14)岁。A组和B组切口长度分别为(8.4±1.4)cm和(15.3±3.0)cm;出血量分别为(151±26)ml和(319±33)ml;术中透视次数分别为(14.1±2.9)次和(8.2±1.7)次;手术时间分别为(44±9)min和(73±11)min;骨折愈合时间分别为(55±12)d和(80±13)d。术后1年,A组和B组Harris评分分别为(86±4)分和(82±4)分;Harris评分优良率分别为92.4%和88.7%。经皮双改锥微创复位组切口长度更小,出血量更少,骨折愈合时间更短,Harris评分更高(P<0.05)。结论经皮双改锥微创复位技术在处理难复性股骨粗隆间骨折患者时,优于有限切开复位术。其可作为难复性股骨粗隆间骨折的首选复位方法,值得临床广泛推广。Objective The purpose of this study was to compare the clinical effects of percutaneous double screwdriver minimally invasive reduction and limited open reduction in the treatment of irreducible femoral intertrochanteric fractures.Methods From January 2016 to January 2018,a total of 145 patients with irreducible femoral intertrochanteric fractures were treated in Xi'an Honghui hospital.128 patients received complete follow-up,of which 66 received percutaneous double screwdriver minimally invasive reduction(Group A)and 62 received limited open reduction(Group B)treatment.All patients were classified according to Evans-Jensen classification and fixed with proximal femoral nail anti-rotation(PFNA).The operation indexes were observed,including incision length,bleeding volume,intraoperative fluoroscopy times and operation time.All patients were followed up for at least one year.The bone healing,complications and Harris score of hip joint were counted.Results 128 patients were completely followed up.The mean follow-up time was(19±4)months.There were 58 males and 70 females,with an average age of(66±14)years.The incision length of Group A and B were(8.4±1.4)cm and(15.3±3.0)cm,respectively.The bleeding volume was(151±26)ml and(319±33)ml.The times of intraoperative fluoroscopy were(14.1±2.9)and(8.2±1.7).The operation time was(44±9)min and(73±11)min,respectively.The fracture healing time was(55±12)d and(80±13)d.One year after operation,the Harris scores of Group A and B were(86±4)and(82±4),respectively.The excellent and good rates of Harris score were 92.4%and 88.7%.Percutaneous double screwdriver minimally invasive reduction group had shorter incision length,less bleeding,shorter fracture healing time and higher Harris score(P<0.05).Conclusions The clinical effects of percutaneous double screwdriver minimally invasive reduction group was better than that of limited open reduction group.Percutaneous double screwdriver minimally invasive reduction technique can be used as the first choice for the reduction of

关 键 词：髋骨折 微创 复位 

分 类 号：R687.3[医药卫生—骨科学]