两种术中牵引复位SeinsheimerⅤ型股骨转子下骨折

Two intraoperative traction methods for reduction of Seinsheimer type V femoral subtrochanteric fractures

摘要:

[目的] 比较下肢轴向牵引器 （lower extremity axial distractor, LEAD） 与牵引床辅助复位髓内钉内固定治疗 Sein- sheimerⅤ型股骨转子下骨折的临床疗效。[方法] 回顾性分析 2012 年 5 月—2021 年 5 月在本院行髓内钉内固定治疗的 49 例 SeinsheimerⅤ型股骨转子下骨折患者的临床资料。根据术前医患沟通结果，29 例使用 LEAD 复位（牵引器组），20 例使用牵引床复位 （牵引床组）。比较两组围手术期、随访及影像资料。[结果] 牵引器组安装牵引装置时间 [(4.0±1.1) min vs (14.0±3.6) min , P＜0.05]、手术时长 [(134.4±33.3) min vs (196.6±103.0) min , P＜0.05]、术中失血量 [(231.0±109.7) ml vs (380.0±247.3) ml , P＜ 0.05]、术中透视次数 [(28.5±4.7) 次 vs (31.8±4.0) 次 , P＜0.05] 均显著优于牵引床组。两组切口总长度、导针定位次数、闭合转切开复位率、切口愈合等级、住院时间、下地行走时间的差异均无统计学意义（P＞0.05）。随访时间平均（15.4±2.5）个月，两组完全负重活动时间差异无统计学意义（P＞0.05）。与术后 1 个月相比，末次随访时，两组 Harris 评分、髋屈-伸 ROM、髋内-外旋 ROM 均显著增加 （P＜0.05）。相应时间点，两组间上述指标的差异均无统计学意义 （P＞0.05）。影像方面，两组骨折复位质量以及骨折愈合时间的差异均无统计学意义（P＞0.05）。[结论]与牵引床相比，下肢轴向牵引器有助于 SeinsheimerⅤ型股骨转子下骨折的复位，可显著缩短手术时长、减少术中失血量并能减少术中透视次数。

Abstract:

[Objective] To compare the clinical efficacy of lower extremity axial distractor (LEAD) versus conventional traction table (CTT) assisted fracture reduction and intramedullary nailing in the treatment of Seinsheimer type Ⅴ femoral subtrochanteric fractures. [Methods] A retrospective study was performed on 49 patients who received fracture reduction and intramedullary nailing for Seinsheimer type Ⅴ femoral subtrochanteric fracture in our hospital from May 2012 to May 2021. According to preoperative doctor-patient communica- tion, LEAD reduction was used in 29 patients, while CTT reduction used in the remaining 20 patients. The perioperative period, follow-up and imaging data of the two groups were compared. [Results] The LEAD group proved significantly superior to the CTT group in terms of traction device installation time [(4.0±1.1) min vs (14.0±3.6) min, P＜0.05], operation time [(134.4±33.3) min vs (196.6±103.0) min, P＜ 0.05], intraoperative blood loss [(231.0±109.7) ml vs (380.0±247.3) ml, P＜0.05], intraoperative fluoroscopy [(28.5±4.7) times vs (31.8±4.0) times, P＜0.05], nevertheless there were no significant differences in the total incision length, guide needle positioning times, closed-open reduction rate, incision healing grade, hospital stay, and walking time between the two groups (P＞0.05). All of them were followed up for (15.4±2.5) months on a mean, and there was no significant difference in the time to resume full weight-bearing activities between the two groups (P＜0.05). Compared with those 1 month after surgery, the Harris score, hip flexion-extension range of motion (ROM), and hip inter- nal-external rotation ROM significantly increased in both groups at the last follow-up (P＜0.05), which proved not significantly different be- tween the two groups at any time points accordingly (P＞0.05). In terms of imaging, there were no significant differences in the quality of fracture reduction or the imaging fracture healing time between the two groups (P＞0.05). [Conclusion] Compared with conventional traction table, the lower extremity axial distractor does shorten operation time, reduce intraoperative blood loss and reduce intraoperative fluorosco- py times considerably for intramedullary nailing Seinsheimer type Ⅴ femoral subtrochanteric fractures.