牵引床结合直接撬拨关键点复位法在AO/OTA-A1型难复性股骨粗隆间骨折内固定术中的应用  

Application of traction bed combined with direct prying“key point”reduction method in internal fixation of AO/OTA-A1 irreducible femoral intertrochanteric fractures of femur

作　　者：骆鑫晨 游荣 刘梓冰 李光辉 段建辉 LUO Xinchen;YOU Rong;LIU Zibing;LI Guanghui;DUAN Jianhui(Department of Orthopaedics,Changde First Hospital of Traditional Chinese Medicine,Changsha,Hunan 410000,China)

机构地区：[1]常德市第一中医医院骨伤科,湖南415000

出　　处：《中国骨与关节损伤杂志》2024年第8期799-803,共5页Chinese Journal of Bone and Joint Injury

基　　金：湖南省卫生健康委员会卫生适宜技术推广项目(202319015932)。

摘　　要：目的观察牵引床结合直接撬拨关键点复位法在AO/OTA-A1型难复性股骨粗隆间骨折内固定术中的应用效果。方法回顾性分析自2020-01—2022-12诊治的40例股骨粗隆间骨折,根据骨折复位情况分为2组,其中A组为易复性股骨粗隆间骨折,闭合复位时骨折容易复位,即在牵引床上通过牵引、内收、内旋等过程可达到满意复位;B组为难复性股骨粗隆间骨折,即在牵引床上通过牵引、内收、内旋等过程无法达到满意复位,采用牵引床结合直接撬拨关键点法进行骨折复位;两组均采用股骨近端联合交锁髓内钉内固定。比较两组手术时间、术中出血量、术后3个月髋关节功能Harris评分。结果所有患者均获得随访,随访时间3~5个月,平均3.6个月。术中无血管损伤,术后无切口感染发生。两组手术时间比较,差异无统计学意义(t=-1.483,P=0.142)。两组术中出血量比较,差异无统计学意义(t=1.747,P=0.089)。两组术后3个月髋关节功能Harris评分比较,差异无统计学意义(t=0.498,P=0.567)。结论牵引床结合直接撬拨关键点复位法在AO/OTA-A1型难复性股骨粗隆间骨折内固定术中复位效果好,临床疗效满意。Objective To observe the effect of traction table combined with direct prying“key point”reduction method in the internal fixation of AO/OTA-A1 irreducible femoral intertrochanteric fractures of femur.Methods A retrospective analysis was performed on 40 cases of intertrochanteric femoral fractures diagnosed and treated from January 2020 to December 2022,which were divided into two groups according to fracture reduction.Group A was easily reducible intertrochanteric fractures of femur,which were easily reduced during closed reduction by traction,adduction and internal rotation on the traction table.Group B consisted of irreducible intertrochanteric fractures,which could not be reduced satisfactorily by traction,adduction or internal rotation on the traction table,so the traction table combined with direct“key point”was used for fracture reduction.The proximal femur combined with interlocking intramedullary nail(InterTan)was used for internal fixation in both groups.Operation time,intraoperative blood loss and Harris score of hip function 3 months after operation were compared between the two groups.Results All patients were followed up for more than 3~5 months,with an average of 3.6 months.There was no vascular injury during operation and no incision infection after operation.There was no statistical difference in operation time between the two groups(t=-1.483,P=0.142).There was no significant difference in intraoperative blood loss between the two groups(t=1.747,P=0.089).There was no statistical difference in the Harris score of hip function 3 months after surgery between the two groups(t=0.498,P=0.567).Conclusion Traction table combined with direct prying key point reduction method in AO/OA-A1 irreducibe femoral intertrochanteric fractures achieves good reduction effect and satisfactory clinical efficacy.

关 键 词：股骨粗隆间骨折 牵引床 撬拨复位 内固定 手术技巧 

分 类 号：R687.3[医药卫生—骨科学]