自制牵引复位器在股骨粗隆间骨折内固定应用

A novel self-developed device for traction and fracture reduction used in internal fixation of femoral intertrochanteric fracture with proximal femoral nail anti-rotation

[目的]介绍自制骨折牵引复位器在髓内钉内固定治疗股骨粗隆间骨折的手术技术与初步结果。[方法] 2016年12月~2019年3月应用骨折牵引复位器牵引复位PFNA内固定治疗股骨粗隆间骨折36例。患者取斜卧位,分别于髂嵴和股骨髁上置钉,连接牵引复位器,纵向牵引,矫正短缩和髋内翻畸形。透视引导下置入PFNA内固定。[结果]骨折牵引复位器安装时间(18.13±1.51) min、复位时间(7.12±1.89) min、手术时间(49.80±4.55) min、透视时间(3.57±0.63) min、失血量(193.20±12.11) ml、有限切开复位比率15.85%、助手人数1 (1~2)人。平均随访时间(16.60±2.41)个月、患者下地行走时间(15.12±3.23) d、完全负重活动时间(15.12±5.07)周、骨折愈合时间(4.87±1.78)个月、末次随访时髋关节功能Harris评分(83.36±3.87)分。[结论]自制骨折牵引复位器在髓内钉内固定治疗股骨粗隆间骨折中应用复位成功率高,并发症少,能缩短复位和手术时间。

[Objective] To introduce the surgical technique and primary clinical outcomes of a novel self-developed device for traction and fracture reduction in internal fixation of femoral intertrochanteric fractures with proximal femoral nail anti-rotation(PFNA). [Methods] From December 2016 to March 2019, a total of 36 patients underwent internal fixation with PFNA for femoral intertrochanteric fractures using the novel self-developed device for traction and fracture reduction. After the patients were placed in oblique lateral position,pins inserted in iliac crest and femoral supracondyle were attached to the device, by which the axial traction was applied to correct the shortening and coxa varus deformities and achieve fracture reduction. After that, PFNA was placed under fluoroscopic guidance. [Results] All the patient had operation finished smoothly with the device installation time of(18.13±1.51) min, fracture reduction time of(7.12±1.89)min, operation time of(49.80±4.55) min, X-ray exposure time of(3.57± 0.63) min, and intraoperative blood loss of(193.20 ± 12.11) ml.The limited open reduction accounted for 15.85%, with only 1 or 2 assistants in operation. The patients were followed up for(16.60±2.41) months. The fracture healing time was of(4.87±1.78) months. The walking time was(15.12±3.23) d, and the time of full weightbearing activity was(15.12±5.07) w. Whereas Harris score of hip joint function was of(83.36±3.87) at the latest follow-up. [Conclusion]This novel self-developed device does facilitate PFNA internal fixation for femoral intertrochanteric fractures with benefits of shortening fracture reduction time and operation time and reducing complications.