双反牵引复位微创经皮钢板接骨术治疗老年股骨远端骨折的疗效  

Efficacy of double reverse traction reduction combined with minimally invasive percutaneous plate osteosynthesis in the treatment of distal femoral fractures in the elderly

作　　者：姚孟轩 赵阔 金霖[1] 马利杰[1] 郑占乐[1] 侯志勇[1] 张英泽[1] 陈伟[1] Yao Mengxuan;Zhao Kuo;Jin Lin;Ma Lijie;Zheng Zhanle;Hou Zhiyong;Zhang Yingze;Chen Wei(Trauma Emergency Center,Third Hospital of Hebei Medical University,Hebei Key Laboratory of Biomechanics,Key Laboratory of Intelligent Orthopedic Equipment,National Health Commission,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院创伤急救中心,河北省生物力学重点实验室,国家卫生健康委智能骨科装备重点实验室,石家庄050051

出　　处：《中华创伤杂志》2024年第12期1093-1099,共7页Chinese Journal of Trauma

摘　　要：目的比较双反牵引复位微创经皮钢板接骨术(MIPO)与传统复位MIPO治疗老年股骨远端骨折的疗效。方法采用回顾性队列研究分析2021年1月至2023年6月河北医科大学第三医院收治的78例老年股骨远端骨折患者的临床资料,其中男16例,女62例;年龄60~85岁[(74.5±7.1)岁]。骨密度T值(-2.1±0.9)SD。骨折按骨科创伤协会(OTA)分型:33⁃A1型27例,33⁃A2型36例,33⁃A3型15例。43例行传统复位MIPO治疗(传统复位组),35例行双反牵引复位MIPO治疗(双反牵引复位组)。比较两组手术时间、术中出血量、术中透视次数、初次骨痂形成时间、影像学愈合时间;术后1、3个月及末次随访时膝关节屈伸活动度和膝关节协会评分(KSS);术后并发症发生率。结果患者均获随访6~18个月[(14.4±2.6)个月]。双反牵引复位组手术时间为(73.7±7.6)min,术中出血量为(112.4±32.3)ml,术中透视次数为(9.8±4.5)次,均短于或少于传统复位组的(95.2±10.0)min、(139.7±49.5)ml、(15.2±3.9)次(P<0.01)。两组初次骨痂形成时间差异无统计学意义(P>0.05)。双反牵引复位组影像学愈合时间为(25.9±5.1)周,短于传统复位组的(29.6±8.2)周(P<0.05)。双反牵引复位组术后1个月膝关节屈伸活动度为(96.4±5.0)°,大于传统复位组的(93.9±3.7)°(P<0.05),术后3个月及末次随访时两组差异均无统计学意义(P>0.05)。术后1、3个月及末次随访时,两组KSS差异均无统计学意义(P>0.05)。双反牵引复位组无畸形愈合,传统复位组畸形愈合发生率为9.3%(4/43)(P>0.05);两组均未出现感染或切口不愈合。结论与传统复位MIPO相比,双反牵引复位MIPO治疗老年股骨远端骨折可缩短手术时间、减少术中出血量和透视次数、促进骨折愈合及早期膝关节活动度恢复。Objective To compare the efficacy of double reverse traction reduction combined with minimally invasive percutaneous plate osteosynthesis(MIPO)and traditional reduction combined with MIPO in treating distal femoral fractures in the elderly.Methods A retrospective cohort study was conducted to analyze the clinical data of 78 elderly patients with distal femoral fractures admitted to Third Hospital of Hebei Medical University from January 2021 to June 2023,including 16 males and 62 females,aged 60⁃85 years[(74.5±7.1)years].The bone mineral density T⁃score was(-2.1±0.9)SD.According to the Orthopedic Trauma Association(OTA)classification,the fractures were classified as type 33⁃A1 in 27 patients,type 33⁃A2 in 36,and type 33⁃A3 in 15.Forty⁃three patients underwent traditional reduction combined with MIPO(traditional reduction group),while 35 patients received double reverse traction reduction combined with MIPO(double reverse traction group).The two groups were compared in terms of operation time,intraoperative blood loss,number of intraoperative fluoroscopies,time to initial callus formation,radiographic healing time,range of motion of knee flexion and extension and Knee Society score(KSS)at 1 and 3 months postoperatively and at the last follow⁃up,and the incidence of postoperative complications.Results All the patients were followed up for 6⁃18 months[(14.4±2.6)months].The operation time,intraoperative blood loss and number of intraoperative fluoroscopies were(73.7±7.6)minutes,(112.4±32.3)ml,and(9.8±4.5)times in the double reverse traction group,which were significantly reduced compared with those in the traditional reduction group[(95.2±10.0)minutes,(139.7±49.5)ml,(15.2±3.9)times]in the traditional reduction group(P<0.01).There was no significant difference in the time to initial callus formation between the two groups(P>0.05).The radiographic healing time in the double reverse traction group was(25.9±5.1)weeks,shorter than(29.6±8.2)weeks in the traditional reduction group(P<0.05).At 1 mo

关 键 词：股骨骨折 老年人 牵引术 外科手术 微创性 

分 类 号：R687.3[医药卫生—骨科学]