手法复位加单臂外固定架治疗高龄股骨转子间骨折的临床研究

Clinical study on the treatment of intertrochanteric fracture in aged patients through the method of manipulative reduction combined with single-arm external fixator

目的:探讨手法复位加单臂外固定架治疗高龄股骨转子间骨折的临床疗效。方法:将符合要求的90例患者随机分为2组,治疗组60例,对照组30例。治疗组采用手法复位加单臂外固定支架固定治疗;对照组采用动力髋螺钉固定治疗。分别观察记录2组患者的手术时间、术中出血量、骨折愈合时间及术后骨折并发症发生情况,并于患者骨折愈合后采用创伤性髋关节功能评分标准对患者进行髋关节功能评分。结果:①治疗组手术时间、术中出血量及骨折愈合时间均小于对照组(t=15.338,P=0.000;t=33.610,P=0.000;t=21.855,P=0.000),2组髋关节功能评分比较,差异无统计学意义(t=-1.720,P=0.090)。②术后对照组发生深部感染2例,髋内翻1例,螺钉松动部分退出1例,深静脉血栓形成3例;治疗组无骨折并发症发生。结论:手法复位加单臂外固定架在恢复高龄股骨转子间骨折患者髋关节功能方面与动力髋螺钉固定相当,但手术时间短、术中出血量少、骨折愈合时间短、术后并发症也较少,是治疗高龄股骨转子间骨折的有效方法,值得推广应用。

Objective：To explore the clinical curative effect of manipulative reduction combined with single-arm external fixator on the intertrochanteric fracture in aged patients.Methods：90 patients met the criteria were randomly divided into 2 groups.60 cases in the treatment group were administrated with manipulative reduction combined with single-arm external fixator,while the others in the control group were administrated with dynamic hip screw fixation.The operation time,amount of blood loss,fracture healing time and postoperative fracture complications of the patients in the 2 groups were observed and recorded respectively.Hip functions of the patients were scored according to traumatic hip functional scoring standards after fracture healing for the patients.Results：①The operation time,amount of blood loss and fracture healing time of patients in the treatment group were all lower than those of patients in the control group（t=15.338,P=0.000;t=33.610,P=0.000;t=21.855,P=0.000）.There was no statistical difference in the hip functional scores of the patients between the 2 groups（t=-1.720,P=0.090）.②For the control group,deep infection occurred in 2 cases,coxa vara occurred in 1 case,loose screw with partial withdrawal occurred in 1 case and deep leg venous thrombosis occurred in 3 cases after the operation;while for the treatment group,there was no postoperative fracture complications.Conclusion：Although the method of manipulative reduction combined with single-arm external fixator has the clinical effects similar to dynamic hip screw fixation on recovering the hip functions for the aged patients with intertrochanteric fracture,it is an effective method with shorter operation time,less blood loss,shorter fracture healing time and less postoperative fracture complications,and it is worth popularizing in clinic.