横向复位器在股骨转子下骨折微创内固定术中的应用

Application of transverse reduction device in the minimally invasive treatment of subtrochanteric femur fracture

目的介绍横向复位器的设计原理及其在股骨转子下骨折闭合复位中的初步疗效。方法回顾性分析2018年3月—2019年3月深圳市人民医院骨关节外科手术治疗的20例股骨转子下骨折患者资料,男性12例,女性8例;年龄26~72岁,平均54.2岁;摔伤10例,道路交通伤7例,高处坠落伤3例。设计骨牵引复位器并申请专利(ZL201621147799.8),利用对顶牵引机制进行闭合复位且维持复位,加长防旋股骨近端髓内钉(PFNA)或髓内钉固定。随访12~14个月,平均13.2个月。记录术中复位时间、透视次数、切口长度、骨折愈合时间、Harris评分等。结果患者术中复位时间(13.5±3.10)min,复位透视次数(9.2±4.5)次,切口长度(6.1±1.0)cm,骨折愈合时间(13.9±2.8)周;患者术后12个月Harris功能评分(87.7±7.0)分,均未发生髋内翻、骨不连、内固定失效、感染等并发症。结论横向复位器在股骨转子下骨折微创治疗中具有操作简单、复位可靠等优点,值得临床推广。

Objective To introduce the design of transverse reduction device and observe the initial effect in the closed reduction of subtrochanteric fracture of femur.Methods From Mar.2018 to Mar.2019,20 patients(12 males and 8 females,age from 26 to 72,54.2 years on average;10 cases of falling injury,7 cases of road traffic injury,3 cases of falling from high place)with subtrochanteric fracture of femur who have accepted surgeries in Department of Bone and Joint of Shenzhen People’s Hospital were selected.All patients used a transverse reduction device(ZL201621147799.8)for closed reduction of the femoral subtrochanteric fracture,with lengthening PFNA or intramedullary nail for final fixation.The follow-up time was 13.2 months on average,and the reduction time,the reduction times of fluoroscopy,the incision length,the fracture healing time and the Harris function score were recorded.Results In this group,the reduction time was(13.5±3.1)minutes on average,the fluoroscopy times were(9.2±4.5)times on average,the incision length was(6.1±1.0)cm on average,the fracture healing time was(13.9±2.8)weeks on average,and the Harris function score was(87.7±7.0)points on average one year after operation.After surgery,no patient occur complications such as coxa vara,nonunion,failure of internal fixation or infection.Conclusion The initial application of transverse bone traction reduction in the minimally invasive treatment of subtrochanteric fracture of femur has the advantages of simple operation and reliable reduction,which is worth of wide application in clinical practice.