[1]朱佳福,徐卫星,吴震,等.牵抖收展复位结合InterTan髓内钉内固定治疗A2型老年股骨转子间骨折[J].中医正骨,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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牵抖收展复位结合InterTan髓内钉内固定治疗A2型老年股骨转子间骨折()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期数:
2020年02期
页码:
19-22
栏目:
临床研究
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:
朱佳福徐卫星吴震刘宏
(浙江省立同德医院,浙江 杭州 310012)
Author(s):
ZHU JiafuXU WeixingWU ZhenLIU Hong
Tongde Hospital of Zhejiang Province,Hangzhou 310012,Zhejiang,China
关键词:
髋骨折 转子间骨折 骨牵引复位法 骨折固定术髓内 老年人
Keywords:
hip fractures intertrochanteric fractures skeletal tracting reposition fracture fixation intramedullary aged
摘要:
目的:观察牵抖收展复位结合InterTan髓内钉内固定治疗A2型老年股骨转子间骨折的临床疗效及安全性。方法:回顾性分析接受InterTan髓内钉内固定治疗的62例A2型老年股骨转子间骨折患者的病例资料,其中采用牵抖收展复位41例、传统牵引床复位21例。男39例,女23例。年龄65~93岁,中位数82岁。A2.1型骨折51例、A2.2型骨折9例、A2.3型骨折2例。受伤至手术时间3~7 d,中位数4 d。比较2组患者的复位透视次数、手术出血量(术前1 d与术后1 d血红蛋白的差值)、骨折愈合时间及Harris髋关节评分(包括疼痛、关节功能、关节畸形、活动度4项),术后随访观察并发症发生情况。结果:2组患者手术切口均甲级愈合。所有患者均获随访,随访时间9~26个月,中位数13个月。与传统复位组相比,牵抖收展复位组的复位透视次数少[(3.9±0.6)次,(6.2±1.9)次,t=0.262,P=0.029]、手术出血量小[(26.3±1.2)g·L-1,(32.5±2.6)g·L-1,t=0.839,P=0.016],但2组的骨折愈合时间差异无统计学意义[(4.3±0.2)月,(4.6±0.1)月,t=4.159,P=0.081]。牵抖收展复位组1例术后出现夜间谵妄、1例因低蛋白血症出现大量胸腔积液,均经治疗后好转。传统复位组2例因低蛋白血症出现大量胸腔积液,经治疗后好转。末次随访时,2组患者Harris髋关节评分中的疼痛、关节功能、关节畸形、活动度及总分比较,组间差异均无统计学意义[(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]。结论:牵抖收展复位结合InterTan髓内钉内固定治疗A2型老年股骨转子间骨折,安全性高,与传统牵引床复位InterTan髓内钉内固定的综合疗效相当,但复位透视次数少、手术出血量小。
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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备注/Memo

备注/Memo:
(收稿日期:2019-08-21 本文编辑:郭毅曼)基金项目:浙江省医药卫生科技计划项目(2019KY342) 通讯作者:朱佳福 E-mail:158283161@qq.com
更新日期/Last Update: 2020-02-15