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[1]朱佳福,徐衛(wèi)星,吳震,等.牽抖收展復(fù)位結(jié)合InterTan髓內(nèi)釘內(nèi)固定治療A2型老年股骨轉(zhuǎn)子間骨折[J].中醫(yī)正骨,2020,32(02):19-22.
　ZHU Jiafu,XU Weixing,WU Zhen,et al.Traction-shaking-adduction-abduction reduction manipulation combined with InterTan intramedullary nail internal fixation for treatment of type A2 femoral intertrochanteric fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2020,32(02):19-22.
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牽抖收展復(fù)位結(jié)合InterTan髓內(nèi)釘內(nèi)固定治療A2型老年股骨轉(zhuǎn)子間骨折()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期數(shù):
2020年02期
頁碼:
19-22
欄目:
臨床研究
出版日期:
2020-02-20

文章信息/Info

Title:
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; 徐衛(wèi)星; 吳震; 劉宏
(浙江省立同德醫(yī)院,浙江 杭州 310012)
Author(s):
ZHU Jiafu; XU Weixing; WU Zhen; LIU Hong
Tongde Hospital of Zhejiang Province,Hangzhou 310012,Zhejiang,China
關(guān)鍵詞:
髖骨折;  轉(zhuǎn)子間骨折;  骨牽引復(fù)位法;  骨折固定術(shù); 髓內(nèi);  老年人
Keywords:
hip fractures;  intertrochanteric fractures;  skeletal tracting reposition;  fracture fixation;  intramedullary;  aged
摘要:
目的:觀察牽抖收展復(fù)位結(jié)合InterTan髓內(nèi)釘內(nèi)固定治療A2型老年股骨轉(zhuǎn)子間骨折的臨床療效及安全性。方法:回顧性分析接受InterTan髓內(nèi)釘內(nèi)固定治療的62例A2型老年股骨轉(zhuǎn)子間骨折患者的病例資料,其中采用牽抖收展復(fù)位41例、傳統(tǒng)牽引床復(fù)位21例。男39例,女23例。年齡65～93歲,中位數(shù)82歲。A2.1型骨折51例、A2.2型骨折9例、A2.3型骨折2例。受傷至手術(shù)時(shí)間3～7 d,中位數(shù)4 d。比較2組患者的復(fù)位透視次數(shù)、手術(shù)出血量(術(shù)前1 d與術(shù)后1 d血紅蛋白的差值)、骨折愈合時(shí)間及Harris髖關(guān)節(jié)評(píng)分(包括疼痛、關(guān)節(jié)功能、關(guān)節(jié)畸形、活動(dòng)度4項(xiàng)),術(shù)后隨訪觀察并發(fā)癥發(fā)生情況。結(jié)果:2組患者手術(shù)切口均甲級(jí)愈合。所有患者均獲隨訪,隨訪時(shí)間9～26個(gè)月,中位數(shù)13個(gè)月。與傳統(tǒng)復(fù)位組相比,牽抖收展復(fù)位組的復(fù)位透視次數(shù)少[(3.9±0.6)次,(6.2±1.9)次,t=0.262,P=0.029]、手術(shù)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組的骨折愈合時(shí)間差異無統(tǒng)計(jì)學(xué)意義[(4.3±0.2)月,(4.6±0.1)月,t=4.159,P=0.081]。牽抖收展復(fù)位組1例術(shù)后出現(xiàn)夜間譫妄、1例因低蛋白血癥出現(xiàn)大量胸腔積液,均經(jīng)治療后好轉(zhuǎn)。傳統(tǒng)復(fù)位組2例因低蛋白血癥出現(xiàn)大量胸腔積液,經(jīng)治療后好轉(zhuǎn)。末次隨訪時(shí),2組患者Harris髖關(guān)節(jié)評(píng)分中的疼痛、關(guān)節(jié)功能、關(guān)節(jié)畸形、活動(dòng)度及總分比較,組間差異均無統(tǒng)計(jì)學(xué)意義[(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]。結(jié)論:牽抖收展復(fù)位結(jié)合InterTan髓內(nèi)釘內(nèi)固定治療A2型老年股骨轉(zhuǎn)子間骨折,安全性高,與傳統(tǒng)牽引床復(fù)位InterTan髓內(nèi)釘內(nèi)固定的綜合療效相當(dāng),但復(fù)位透視次數(shù)少、手術(shù)出血量小。
Abstract:
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.There was no statistical difference in Harris hip scores including pain scores,joint function scores,joint deformity scores,ROM scores and total scores between the 2 groups at the last follow-up(42.1+/-1.1 vs 41.3+/-1.7 points,t=4.013,P=0.706; 43.3+/-1.7 vs 42.8+/-1.2 points,t=0.225,P=0.063; 3.8+/-0.1 vs 3.5+/-0.3 points,t=1.452,P=0.071; 4.4+/-0.3 vs 4.2+/-0.2 points,t=1.426,P=0.068; 93.7+/-2.5 vs 91.3+/-1.7 points,t=2.923,P=0.087).Conclusion:Traction-shaking-adduction-abduction reduction manipulation combined with InterTan intramedullary nail internal fixation is similar to conventional traction bed-assisted reduction combined with InterTan intramedullary nail internal fixation in total clinical curative effects and safety in treatment of type A2 femoral intertrochanteric fractures in the aged,while the former has such advantages as fewer X-ray exposure and less blood loss compared to the latter.

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備注/Memo

備注/Memo:
(收稿日期:2019-08-21 本文編輯:郭毅曼)基金項(xiàng)目:浙江省醫(yī)藥衛(wèi)生科技計(jì)劃項(xiàng)目(2019KY342) 通訊作者:朱佳福 E-mail:[email protected]
更新日期/Last Update: 2020-02-15