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自行研制的小转子复位器复位固定移位小转子的临床研究
Clinical study on the reduction and fixation of displaced trochanter with self-developed small trochanter restorer
投稿时间:2022-04-18  
DOI:10.3969/j.issn.1672-5972.2023.01.018
中文关键词:  转子间骨折  小转子移位  小转子复位
英文关键词:Intertrochanteric fracture  Lesser trochanter displacement  Lesser trochanter reduction
基金项目:乌鲁木齐市科学技术计划项目(G161310013)
作者单位邮编
杨春* 新疆医科大学附属中医医院新疆 乌鲁木齐830000 830000
程国杰 新疆医科大学附属中医医院新疆 乌鲁木齐830000 830000
吕刚 新疆医科大学附属中医医院新疆 乌鲁木齐830000 830000
吴迎春 新疆医科大学附属中医医院新疆 乌鲁木齐830000 830000
王筠 新疆医科大学附属中医医院新疆 乌鲁木齐830000 830000
马雷 新疆医科大学附属中医医院新疆 乌鲁木齐830000 830000
王国选 新疆医科大学附属中医医院新疆 乌鲁木齐830000 830000
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中文摘要:
      目的 评价自行研制的小转子复位器复位固定移位的波及后内侧小转子骨块或大转子后外侧骨块的临床效果。方法 将2017年1月至2018年12月新疆医科大学附属中医医院收治的30例股骨转子间骨折(Futamura A3型骨折中的后内侧小转子骨块或大转子后外侧骨块)患者采用随机信封法分为两组,两组患者都选用PFNA(AO)进行闭合复位内固定:实验组(15例)采用自行研制的小转子复位器对移位的小转子进行复位后空心螺钉固定;对照组(15例)不处理移位的小转子。比较两组的手术时间、术中出血量、术后下地时间、髋关节功能Harris评分、髋部骨折功能恢复量表评分、术后并发症及不良反应发生率。结果 两组患者均获得随访,平均随访(14.1±2.3)个月。实验组的手术时间、术中出血量均多于对照组,实验组下地时间早于对照组,两组比较差异有统计学意义(P<0.05);实验组术后1个月患髋关节Harris评分及髋部骨折功能恢复量表评分均优于对照组,差异有统计学意义(P<0.05);两组术后3个月及1年Harris评分及髋部骨折功能恢复量表评分比较,差异无统计学意义(P>0.05)。两组均无伤口感染、头钉切割、假体周围骨折、下肢深静脉血栓形成等并发症。术后不良反应(饮食差、便秘、术后发热)实验组与对照组相当,差异无统计学意义(P>0.05)。结论 对于股骨转子间骨折伴后内侧小转子骨块和大转子后外侧骨块移位患者,术中采用自行研制的小转子复位器复位固定移位的后内侧小转子骨块或大转子后外侧骨块,早期髋关节功能优于不复位组,后期功能无差异。建议对于合并严重并发症的高龄患者,为缩短手术时间,不推荐术中复位固定移位的后内侧小转子骨块或大转子后外侧骨块。
英文摘要:
      Objective To evaluate the clinical effect of a self-made trochanter for reduction and fixation of displaced bone fragments involving the posterior medial lesser trochanter or the posterior lateral greater trochanter.Methods A prospective randomized study was carried out from January 2018 to October 2019 involving 30 elderly patients with intertrochanteric fractures (Futamura for posterior medial lesser trochanter and posterior lateral greater trochanter in type A3 fractures) who underwent minimally invasive surgery using the PFNA. Using random envelope grouping method, one group treated with displaced fragments by self-developed intertrochanteric reduction device reducing and fixing it, while another group was ignored. Evaluation variables, including operation time, intraoperative blood loss, weight bearing time, postoperative complications, incidence of postoperative adverse reactions, and final clinical outcomes by the end of follow-up were used to compare the benefits of these two therapeutic methods.Results The mean followed-up time was (14.1±2.3) months. The mean operation time was prolonged, and intraoperative blood loss was more when the displaced trochanter reducted and fixed by self-developed intertrochanteric reduction device. There was a statistical significance between the mean operation time and the intraoperative blood loss (P<0.05). The weight bearing time in the experimental group was earlier than that in the control group, there was a statistical significance between the two groups (P<0.05). The mean Harris score and FRS score in the experimental group were better than those in the control group at 1 month after operation, with statistical significance (P<0.05), while at 3 months, 1 year after operation, and there was no statistical significance between the two groups (P>0.05). There were no wound infection, cut-out of head, periprosthetic fractures, thrombosis of deep veins of lower limbs between the two groups. Postoperative adverse reactions (poor diet, constipation, postoperative fever) in the experimental group were equivalent to those in the control group, with no statistical significance (P>0.05).Conclusion The self-developed intertrochanteric reduction device aid in early mobilization and early return of ambulatory function with more surgical time and blood loss. However, for the elderly with severe complications, in order to shorten the operation time, reduction and fixation of displaced trochanter is not recommended.
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