顶棒支撑法复位配合微创双通道技术对不同临床分型难复性股骨转子间骨折的临床疗效  

Clinical efficacy of top rod support method combined with minimally invasive dual channel technology in the treatment of refractory intertrochanteric fractures of the femur with different clinical classifications

作　　者：蒋健 王龙 冯骁 王海波 JIANG Jian;WANG Long;FENG Xiao;WANG Hai-bo(Department of Orthopedics,Affliated Hospital of Xuzhou Medical University,Xuzhou 221000,China)

机构地区：[1]徐州医科大学附属医院骨科,江苏徐州221000

出　　处：《哈尔滨医科大学学报》2024年第3期254-259,共6页Journal of Harbin Medical University

基　　金：江苏省卫健委科研项目(M2020103)。

摘　　要：目的评估顶棒支撑法复位配合微创双通道技术对不同临床分型难复性股骨转子间骨折的临床疗效。方法选取2020年1月~2023年8月在徐州医科大学附属医院接受治疗的113例股骨转子间骨折患者,根据骨折近端头颈骨块的移位方式,将难复性股骨转子间骨折患者分为3组,其中旋转型组49例、绞锁型组28例、反转子型组36例,采用顶棒支撑法复位结合微创双通道技术治疗,比较分析各组患者手术时间、术中出血量、骨折复位时间、骨折愈合时间、骨折复位情况(颈干角、侧位成角、骨折端侧位重叠率、骨折端前后位重叠率)、骨折复位质量、髋关节Harris评分、术后并发症等指标。结果在手术时间、术中失血量、骨折复位时间和骨折愈合时间方面,3组患者存在显著差异(P<0.05),绞锁型组手术时间最短、失血量最小,旋转型组次之,而反转子组手术时间最长、失血量最大;3组在颈干角、侧位成角、骨折端侧位重叠率和骨折端前后位重叠率上存在显著差异(P<0.05),旋转型组和绞锁型组在这些指标上相对较好,而反转子组相对较差;各组间骨折复位质量没有显著差异(P>0.05),主要以Ⅰ级为主,Ⅳ级较少;3组术后3个月的髋关节Harris评分均明显高于术前,在疼痛、功能、畸形、活动范围和总分上均存在显著差异(P<0.05);3组患者在骨折不愈合、切口感染、固定物脱出以及合计方面均无显著差异(P>0.05)。结论顶棒支撑法复位结合微创双通道技术是一种有效且安全的方法,适用于治疗难复性股骨转子间骨折,尤其在减少手术时间和术中失血量方面表现出较好的临床优势。Objective To evaluate the clinical efficacy of top rod support method combined with minimally invasive dual channel technology in the treatment of different clinical classifications of refractory intertrochanteric fractures of the femur.Methods One hundred and thirteen patients with intertrochanteric fractures of the femur who received treatment in the Affiliated Hospital of Xuzhou Medical University from January 2020 to August 2023 were collected.Based on the displacement of the proximal head and neck bone fragments of the fractures,patients with refractory intertrochanteric fractures were divided into 3 groups,including 49 cases of rotational type group,28 cases of twisted lock type group,and 36 cases of reverse rotor type group.All patients were treated with top rod support method combined with minimally invasive dual channel technology,and the surgical time,intraoperative blood loss,fracture reduction time,fracture healing time,fracture reduction status(neck shaft angle,lateral angle,lateral overlap rate of fracture end,anterior posterior overlap rate of fracture end),fracture reduction quality,Harris score of hip joint,postoperative complications and other indicators in each group of patients were compared and analyzed.Results In terms of surgical time,intraoperative blood loss,fracture reduction time,and fracture healing time,there were significant differences among the three groups of patients(P<0.05).The interlocking group showed the shortest surgical time and the smallest blood loss,followed by the rotating group,while the reverse rotor group showed the longest performance;There were significant differences among the three groups in terms of neck shaft angle,lateral angle,lateral overlap rate of fracture end,and anterior posterior overlap rate of fracture end(P<0.05);The rotary and twisted lock groups perform relatively well on these indicators,while the reverse rotor group performs relatively poorly;The evaluation of the quality of fracture reduction showed no significant difference among the groups(P>0

关 键 词：顶棒支撑法 微创双通道技术 难复性股骨转子间骨折 临床分型 复位质量 

分 类 号：R683.42[医药卫生—骨科学]