应用特殊复位器经皮摇杆复位顺行髓内钉治疗股骨干骨折的临床研究

Displacement femoral shaft fractures treated by intramedullary nailing with joysticks technique under the assistance of an special reduction device

目的探讨应用特殊复位器经皮摇杆复位顺行髓内钉(intramedullary nailing,IMN)治疗移位股骨干骨折(fracture of shaft of femur,FSFs)的手术方法和临床疗效。方法将单侧股骨干骨折患者76例随机分为对照组(39例)和观察组(37例),对照组采用传统复位方法IMN固定治疗移位FSFs,观察组应用特殊复位器(T形钉)作为摇杆经皮复位IMN固定治疗移位FSFs。比较2组手术时间、术中复位时间、透视时间、术中出血量,观察并记录患者术后患肢骨折愈合时间及功能恢复情况。结果观察组应用T形钉复位均达到闭合复位,对照组4例患者需切开复位;观察组手术时间、复位时间、术中透视时间、术中出血量明显短于或少于对照组,差异有统计学意义(P<0.05)。2组骨折愈合时间及优良标准率差异无统计学意义(P>0.05)。结论应用特殊复位器(T形钉)经皮摇杆复位IMN固定治疗移位FSFs具有快速闭合复位、手术时间短、出血量少、透视时间短、功能恢复好等优点,值得临床应用和推广。

Objective To evaluate the surgical skills and curative effect of anterograde intramedullary nailing（IMN）in the treatment of displacement femoral shaft fractures（FSFs）under the assistance of an reduction device by percutaneous joystick techniques.Methods The 76 adult patients with unilateral displacement FSFs were enrolled into this study and were randomly divided into control group（39 cases）and observation group（37 cases）.The patients of control group were treated with IMN using conventional methods to reduce femoral shaft fracture.The patients of observation group were treated with IMN via a novel percutaneous technique that employs T tape pin reduction device which used as a ＂joystick＂to align the femoral shaft fractures.The operation time,fluoroscopy time,and intra-operative blood loss of two groups were compared.Follow-up was conducted to assess the healing time of the fractures and the functional recovery of the affected limbs.Results All the fractures were reduced in the closed fashion in observation group under the assistance of T tape pin reduction device.In control group,4 cases were reduced via open reduction.The operation time,reduction time,fluoroscopy time and intra-operative blood loss in observation group was significantly less than that in control（P〈0.05）.The fracture union time and functional recovery between groups were no significant differences（P〈0.05）.Conclusion The displacement FSFs treated with IMN under the assistance of the T tape pin redaction device by percutaneous techniques is a good choice with the advantages of rapid reduction,short operative time,less intra-operative blood loss,less fluoroscopy time and excellent functional recovery,so it is worthy of popularizing in clinic.