自制简易牵引架在股骨粗隆间骨折手术中的应用

Application of do-it-yourself simple traction frame in intertrochanteric fracture operation

目的探讨自制简易牵引架在股骨粗隆间骨折手术中的应用效果。方法收集30例牵引器辅助下侧卧位闭合复位股骨近端防旋髓内钉(PFN-A)内固定治疗者为实验组,同时收集15例独立牵引架辅助下平卧位PFN-A治疗者为对照组。记录两组平均手术时间、术中出血量、术中导针插入失败次数及术中透视次数,记录两组术后并发症。随访6~24个月,平均为(12.6±1.8)个月,评价两组复位质量及肢体功能情况。结果实验组平均手术时间明显短于对照组,术中出血量明显少于对照组,导针插入失败次数明显少于对照组,术中透视次数少于对照组,P<0.05。实验组术后并发症率3.33%(1/30),明显低于对照组26.67%(4/15),χ~2=5.512,P=0.018;复位质量及肢体功能优良率与对照组比较,P>0.05。结论相比独立牵引架辅助下平卧位PFN-A来说,采用牵引器辅助下侧卧位PFN-A可缩短手术时间,减少术中出血量及术中透视次数,降低导针插入失败次数,减少术后并发症,取得较好的复位质量,促进患者肢体功能恢复,因此具有较高应用价值。

Objective To investigate the effect of self-made simple traction frame in the operation of intertrochanteric fracture. Methods 30 cases of closed reduction and internal fixation with proximal femoral nail anti rotation（PFN-A） were performed in the experimental group.At the same time, 15 cases of PFN-A treated with independent traction frame under supine position were selected as control group.The mean operative time,intraoperative blood loss, the number of insertion failures and the number of intraoperative fluoroscopy were recorded in the two groups.The postopera-tive complications were recorded in two groups. All patients were follow up for 6-24 months,the average was（12.6 ±1.8） months.The quality of the two groups and the physical function of the limbs were evaluated. Results The average operation time of the experimental group was significantly short-er than that of the control group.The amount of bleeding in the operation was significantly less than that of the control group（ P〈0.05）.The number of needle insertion failures was less than that of the control group（ P〈0.05）.The frequency of intraoperative fluoroscopy was less than that of the control group（P〈0.05）.The postoperative complication rate in the experimental group was 3.33%, which was significantly lower than that in the control group（26.67%）（P〈0.05）. The excellent and good rate of reduction and limb function hadno different than those of the control group（ P〈0.05）. Conclusion Compare with the independent tractor assisted prone position PFN-A, the use of a tractor to assist the lower position of PFN-A could shorten the op-eration time,reduce the amount of intraoperative bleeding and intraoperative fluoroscopy times,reduce the number of needle insertion failures,Reduce the postoperative complications, and had better quality of reduction, promote the recovery of the body function. Therefore, it is of high application val-ue.