分步复位与有限切开复位髓内钉固定治疗股骨转子下骨折的疗效比较

Comparison of intramedullary nail fixation following two-step closed reduction or limited open reduction for femoral subtrochanteric fractures

目的:比较分步闭合复位髓内钉固定与有限切开复位髓内钉固定治疗股骨转子下骨折的临床疗效。方法:回顾性分析2014年1月至2020年4月符合纳入标准的46例股骨转子下骨折患者,采用仰卧位分二步闭合复位髓内钉固定24例(闭合复位组),男16例,女8例,年龄34~91(55.42±18.25)岁。采用有限切开复位髓内钉固定22例(有限切开组),其中男15例,女7例,年龄33~87(56.31±14.77)岁。记录两组患者的手术时间,术中出血量,并发症,骨折愈合时间。术后8个月随访时采用髋关节Harris评分系统评估关节功能。结果:所有患者顺利完成手术,无切口感染发生。所有患者获得随访,时间8~36(18.2±6.1)个月。闭合复位组术中出血量、手术时间分别为(157.92±51.07)ml、(82.08±13.43)min,有限切开组分别为(230.91±87.88)ml、(92.73±12.79)min,两组比较差异有统计学意义(P<0.05);两组骨折愈合时间比较差异无统计学意义(P>0.05)。两组术后并发肺部感染各2例,经内科治疗后痊愈。术后8个月闭合复位组Harris评分(88.42±6.85)分与有限切开组(88.55±6.31)分比较差异无统计学意义(P>0.05)。结论:分步闭合复位髓内钉固定及有限切开复位髓内钉固定治疗股骨转子下骨折均可获得满意效果,但分步复位髓内钉固定手术创伤小,手术时间短,术中出血少。

Objective:To compare clinical efficacy of intramedullary nail fixation following two-step closed reduction or limited open reduction for femoral subtrochanteric fractures.Methods:Forty-six patients with femoral subtrochanteric fractures were analyzed retrospectively from January 2014 to April 2020.Twenty-four patients which including 16 males and 8 females,aged from 34 to 91 years old with an average of(55.42±18.25)years old,were treated with two-step closed reduction and intramedullary nail fixation on supine position.Twenty-two patients which including 15 males and 7 females,aged from 33 to 87 years old with an average of(56.31±14.77)years old,were performed limited open reduction and intramedullary nail fixation.Operation time,intraoperative blood loss,complications and fracture healing time were recorded and compared between two groups.Postoperative Harris hip score at 8 months was applied to evalaute joint function.Results:All patients were successfully complete operation without incision infection.All patients were followed up from 8 to 36 months with an average of(18.2±6.1)months.Introperation blood loss,operation time in closed reduction group were(157.92±51.07)ml,(82.08±13.43)min respectively,while in limited open reduction group were(230.91±87.88)ml,(92.73±12.79)min respectively;while there were statistical difference between two groups(P<0.05).There was no difference in fracture healing time between two groups(P>0.05).There were 2 patients in each groups occurred pulmonary infection and healed after medical treatment.No statistical difference in postoperative Harris score at 8 months between closed reduction group(88.42±6.85)and limited open reduction group(88.55±6.31)(P>0.05).Conclusion:Femoral subtrochanteric fractures could be effectively treated by both methods.Two-step closed reduction and intramedullary nail fixation may be more advantageous in less tissue damage,shorter operation time and less intraoperative bleeding.