新型牵引床闭合复位髓内钉固定股骨粗隆间骨折△

A novel traction table for closed reduction intramedullary nailing of femoral intertrochanteric fractures

摘要:

[目的] 评价新型牵引床在闭合复位髓内钉固定股骨粗隆间骨折中的临床效果。[方法] 2019 年12 月—2022 年4 月本院收治的72 例股骨粗隆间骨折患者随机分为两组，36 例术中应用新型牵引床（新型组），36 例应用传统牵引床（传统组）。比较两组围手术期、随访与影像结果。[结果] 新型组体位摆放时间[(5.9±1.5) min vs (13.6±3.3) min, P＜0.001]、麻醉时间[(101.5±13.2) min vs (137.3±18.7) min, P＜0.001]、术中透视次数[(34.1±4.1) 次vs (38.2±5.5) 次, P＜0.001] 显著优于传统组，两组闭合复位时间、手术时间、切口总长度、术中失血量、切口愈合等级、住院时间、完全负重时间的差异均无统计学意义（P＞0.05）。末次随访时，两组VAS 评分、Harris 评分、髋伸-屈ROM、髋内-外旋ROM 均显著改善（P＜0.05），相应时间点，两组上述指标的差异均无统计学意义（P＞0.05）。影像方面，两组骨折复位评级、骨折愈合时间的差异均无统计学意义（P＞0.05）。末次随访时，两组股骨颈干角（femoral neck-shaft angle, FNSA） 均显著减小（P＜0.05），而顶尖距（tip-apex distance, TAD） 无显著变化（P＞0.05）。相应时间点两组间FNSA、TAD 的差异均无统计学意义（P＞0.05）。[结论] 新型牵引床能够有效减少体位摆放时间与透视次数，并且不会增加手术时间与闭合复位时间，减少了麻醉时间，提高了手术效率。

Abstract:

[Objective] To evaluate the clinical efficiency of a novel traction table used in closed reduction and intramedullary nailingof femoral intertrochanteric fractures. [Methods] From December 2019 to April 2022, a total of 72 patients who admitted to our hospital forfemoral intertrochanteric fractures were randomly divided into two groups. Of them, 36 patients received operation under the novel tractiontable (the novel group), while other 36 patients were under the traditional fracture table (the traditional group). The perioperative, follow-upand imaging documents were compared between the two groups. [Results] The novel group proved significantly superior to the traditionalgroup in terms of positioning time [(5.9±1.5) min vs (13.6±3.3) min, P＜0.001] and anesthesia time [(101.5±13.2) min vs (137.3±18.7) min,P＜0.001], intraoperative fluoroscopy times [(34.1±4.1) times vs (38.2±5.5) times, P＜0.001], despite of no statistically significant differencesin closed reduction time, operation time, total incision length, intraoperative blood loss, incision healing grade, hospital stay, and time to re-gain full weight-bearing time between the two groups (P＞0.05). The VAS score, Harris score, hip extension-flexion range of motion (ROM),and hip internal-external rotation ROM were significantly improved in both groups at the latest follow-up compared with those 3 monthspostoperatively (P＜0.05), whereas which were not statistically significant between the two groups at any corresponding time points (P＞0.05).With respect to imaging, there were no statistically significant differences in fracture reduction quality and fracture healing time betweenthe two groups (P＞0.05). At last follow-up, femoral neck-shaft angle (FNSA) decreased significantly in both groups (P＜0.05), while tipapexdistance (TAD) remained unchanged (P＞0.05). There were no significant differences in FNSA and TAD between the two groups at anycorresponding time points (P＞0.05). [Conclusion] This new traction table can effectively reduce the time of position placement and times offluoroscopy, and does not increase the operation time and closed reduction time, reduce the anesthesia time, and improve the efficiency ofsurgery.