骨牵引器辅助闭合复位PFNA内固定股骨转子间骨折

Skeletal tractor used in closed reduction and inter nal fixation with proximal femoral nail anti-rotation for femoral intertrochanteric fractures

[目的]探讨骨牵引器辅助闭合复位PFNA内固定技术治疗股骨转子间骨折的临床效果及手术技巧。[方法]回顾性分析2015年6月~2018年1月,骨牵引器辅助闭合复位PFNA内固定技术治疗的76例股骨转子间骨折患者资料。其中,男29例,女47例,平均年龄(69.55±5.12)岁。[结果]76例患者均顺利完成手术,无血管、神经损伤等并发症发生。体位摆放时间平均(8.06±1.41)min,透视次数平均(42.13±5.63)次,手术时间平均(50.04±5.86)min,术中出血量平均(192.34±35.63)ml。19例患者(术前11例、术后8例)发现下肢肌间静脉血栓,无肺栓塞、心脑血管意外等并发症。69例患者获得完整随访,随访时间12~18个月,平均(14.23±2.17)个月。末次随访髋关节Harris评分显著高于术后2个月,差异具有统计学意义(P<0.05)。末次随访VAS评分明显低于术后2个月,差异具有统计学意义(P<0.05)。影像检查方面:所有患者骨折复位良好,内置物位置及防旋螺钉长度满意;骨折12个月内全部愈合,平均愈合时间(11.77±3.17)周。2例患者防旋钉切出,其他患者影像学检查未出现断钉、螺钉松动、移位等情况,无骨折不愈合发生。[结论]骨牵引器辅助闭合复位PFNA内固定技术治疗股骨转子间骨折,无需切开复位,体位摆放时间短,透视次数少,临床效果满意。

[Objective]To evaluate the clinical outcomes and surgical technique of a skeletal tractor applied in close reduction and internal fixation with proximal femoral nail anti-rotation(PFNA)for femoral intertrochanteric fractures.[Meth ods]From June 2015 to January 2018,internal fixation with PFNA was performed under closed reduction with the skeletal trac tor for femoral intertrochanteric fractures in a total of 76 patients,including 29 men and 47 women aged(69.55±5.12)years on average.[Results]All the 76 patients achieved successfully closed reduction and internal fixation with PFNA,with time for pa tient positioning of(8.06±1.41)min,fluoroscopy times of(42.13±5.63),operation time of(50.04±5.86)min and intraoperative blood loss of(192.34±35.63)ml,whereas without iatrogenic neurovascular injuries in anyone of them.The intramuscular venous thrombosis was noted in 19 patients,including 11 cases occurred before operation and 8 cases of them happened after operation,whereas no pulmonary embolism,cardiovascular and cerebrovascular accident were found in anyone of them.Of the 76 patients,69 patients got complete follow up of 12~18 months with an average of(14.23±2.17)months.The Harris score significantly in creased,whereas the VAS score significantly decreased at the latest follow up compared with those at 2 months postoperatively(P<0.05).With regard to radiographic assessment,proper fracture reduction,appropriate implants placed and the blade suitable in length were achieved in all the patients.The fractures healed solidly in 12 months with a mean of(11.77±3.17)weeks.At the latest follow up,no breaking,loosening or displacement of implants and nonunion were found in any patient,except 2 patients who got slight cutting out of the anti-rotation blade.[Conclusion]This skeletal tractor does facilitate closed reduction and PF NA internal fixation with benefits of no need of open reduction,shortening positioning time and fluoroscopy times and achieves satisfactory clinical results for femoral intertrochanteric fractures.