克氏针撬拨辅助复位技术治疗不稳定股骨转子间骨折

Kirschner wire assisted reduction for treatment of unstable intertrochanteric fracture

[目的]探讨克氏针撬拨辅助复位髓内钉内固定治疗老年股骨转子间骨折的疗效。[方法]选取2010年5月~2014年7月在本科住院的年龄〉60岁的EvansⅡ型股骨转子间骨折患者24例,随机分为两组,各12例,均采用美国施乐辉公司的髓内钉Inter Tan治疗,其中牵引床组术中采用牵引床复位;联合组术中采用牵引床与克氏针共同复位,观察两组患者的手术时间、术中出血量、复位质量、负重时间、髋关节功能、骨折愈合时间、术后并发症。[结果]手术时间：牵引床组（39~102）min,平均（65.83±17.23）min,联合组（33~79）min,平均（49.16±12.21）min;术中出血量：牵引床组（105~300）ml,平均（195.83±60.97）ml,联合组（100~250）ml,平均（175.83±48.13）ml;复位质量：牵引床组1例优,7例良,4例差,联合组8例优,4例良;负重时间：牵引床组（17~42）d,平均（24.16±9.65）d,联合组（10~28）d,平均（15.66±4.83）d;髋关节功能按Harris评分标准评定：牵引床组（75~91）分,平均（82.41±4.48）分,联合组（75~91）分,平均（90.08±2.81）分;骨折愈合时间：牵引床组（12~20）周,平均（15.33±2.35）周,联合组（11~17）周,平均（14.08±1.88）周;术后并发症：牵引床组出现3例髋内翻,1例退钉,联合组没有出现并发症。其中性别、年龄、术中出血量、负重时间、骨折愈合时间、术后并发症组间比较差异无统计学意义（P〉0.05）,手术时间、复位质量、髋关节功能评分差异具有统计学意义（P〈0.05）。[结论]克氏针撬拨辅助闭合复位髓内钉内固定治疗股骨转子间骨折具有微创、操作简单、骨折复位良好、手术创伤少、出血少、手术时间短、骨折固定稳定可靠、并发症少等优点,值得推广。

[ Objective ] To explore the curative effect of intertrochanteric fracture reducted with the assist of Kirscher wire. [ Method] Twenty -four cases of Evans II intertroehanteric fracture were selected from 2010 to July 2014 and divided into two groups（ n = 12 in each） randomly. Patients in group A received reduction with traction bed only while in group B, the Kirscher wire and traction bed were used together for reduction. The intramedullary nail（ InterTan nail）was applied in all cases. We recorded operative time, bleeding,reduction, weight loading time, hip function, healing time and complications. [ Result ] The mean operation time was 65.83± 17.23 min （ range, 39 -102 min） in group A, and 49.16 ±12.21 min （ range, 33 - 79 rain） in group B, showing significant difference（P 〈 0.05 ）. The mean intraoperatie blood loss was 195.83 ± 60.97 ml （ range, 105 - 300 ml） in group A,and 175.83 ±48.13 ml（ range,lO0 -250 ml） in group B,indicating no significant difference （ P 〉0.05 ）. The reduction effect evaluation showed that in group A, the good, acceptable and poor outcomes had been achieved in one, seven and four cases,while in group B ,eight good and four acceptable outcomes had been completed, a significant difference was noted be-tween two groups （ P 〈 0. 05 ）. The average weight loading time was 24.16 ± 9.65 days （ range, 17 ±42 days ） in group A,and 15.66 ＋ 4.83 days （range, 10 - 28 days） in group B, without significant difference （P 〉 0.05 ）. The average Harris hip score was g2.41±4.4g（range,75 -91 ） in group A,and 90.08 ± 2. 81 （ range, 75 - 91 ） in group B, with significant difference （ P 〈 0. 05 ）. The average healing time was 15.33±2.35 weeks （ range, 12 ~ 20 weeks） in group A and 14.08 ± 1.88 weeks （ range, 11 - 17 weeks） in group B, without significant difference （ P 〉 0. 05 ）. Four complications were found in group A while in group B, no complication was noticed, indicating no significant difference between two groups （ P 〉 0. 05 ）. [ Conclusion] Kirschner wire assisted reduction for treatment of unstable intertrochanteric fracture is easy to operate ,with less operation time, less complications and good reduction can be achieved.