术前骨牵引与皮牵引对股骨骨折患者手术指标及功能结果的影响

Effect of preoperative skeletal traction and skin traction on operative indicators and functional outcome of patients with femur fractures

目的:比较术前骨牵引与皮牵引固定对成人股骨骨折手术指标及功能结果的影响,从而指导成人股骨骨折术前牵引方法的选择。方法:2008年2月至2012年9月共收治68例年龄大于18岁的股骨骨折患者,根据入院顺序分成两组,奇数采用胫骨结节骨牵引治疗(A组),偶数采用皮牵引治疗(B组)。A组男25例,女9例;平均年龄(36.3±9.9)岁;横形骨折11例,斜形15例,螺旋形8例。B组男26例,女8例;平均年龄(37.1±11.0)岁;横形骨折10例,斜形13例,螺旋形11例。对两组的手术时间、术中出血量、输血人数及输血量、骨折愈合时间、血红蛋白、疼痛评分、功能评分等指标进行对比分析。结果:全部病例获得随访,A组随访时间(33.5±6.5)个月,B组随访时间(31.3±7.5)个月。A组手术时间(108.8±14.2)min,术中出血量(383.1±117.1)ml,术后输血14例,输血量(350.0±122.5)ml,骨折平均愈合时间(15.0±3.3)周,B组手术时间(111.6±12.7)min,术中出血量(392.0±116.7)ml,术后输血11例,输血量(327.3±129.1)ml,骨折平均愈合时间(15.5±3.4)周,两组比较差异均无统计学意义。两组在血红蛋白含量、牵引前后疼痛评分、股骨骨折疗效评分、膝关节功能评分及膝关节活动度方面差异均无统计学意义。结论:相对于皮牵引,骨牵引并不能减少成人股骨骨折的手术时间、出血量、疼痛等临床指标,对于骨折愈合速度及肢体的功能结果也无明显提高。

Objective：To compare the effect on surgical indicators and functional outcome between preoperative skeletal traction and skin traction for adult femoral fracture and guide the choice of preoperative traction method of adult femoral fractures.Methods：From February 2008 to September 2012,68 patients aged greater than 18-year-old with femoral fractures were treated and randomly divided into two groups according hospitalization order,the odd with skeletal traction of tibial tubercle （group A） and the even with skin traction （group B）.In group A,there were 25 males and 9 females with an average age of （36.3±9.9） years old,including 11 cases with transverse fracture,15 cases with oblique fracture,8 cases with spiral fracture.In group B,there 26 males and 8 females with an average age of （37.1±11.0） years old,including 10 cases with transverse fracture,13 cases with oblique fracture,11 cases with spiral fracture.The operative time,blood loss,the number and amount of blood transfusion,fracture healing time,hemoglobin,pain scores and functional scores between two groups were analyzed and compared.Results：All patients were followed up,the follow-up time was （33.5±6.5） months in group A,（31.3±7.5） months in groupB.In group A,the operation time was （108.8± 14.2） min and the intraoperative blood loss was （383.1±117.1） ml and the postoperative blood transfusion was 14 cases and the blood transfusion was （350.0±122.5） ml and the average bone healing time was （15.0±3.3） weeks.In group B,the operation time was （111.6±12.7） min and the intraoperative blood loss was （392.0± 116.7） ml and the blood transfusion was 11 cases and the blood transfusion was （327.3± 129.1） ml and the average healing time was （15.5±3.4） weeks.These obseration indicators had no significant difference between two groups.There was no significant difference between two groups in terms of Hemoglobin,the pain scores before and after traction,the femoral fractures efficacy score,knee function score and knee range.Conclusion：Preoperative skeletal traction does not reduce surgery time,blood loss and pain and so on.The bone healing time and limb functional outcomes were also not significantly improved.