双反牵引复位器与牵引床辅助股骨颈动力交叉钉系统复位固定股骨颈骨折的疗效比较

Comparison of a bidirectional-traction reduction device versus a traction table in treatment of femoral neck fractures with femoral neck system

目的比较双反牵引复位器与牵引床辅助股骨颈动力交叉钉系统(FNS)复位固定股骨颈骨折的疗效。方法回顾性分析2020年1月至2021年1月保定市第一中心医院骨科治疗的46例股骨颈骨折患者资料。男19例, 女27例;年龄30~64岁, 平均47.1岁。骨折根据Garden分型:Ⅲ型29例, Ⅳ型17例。根据辅助复位方式分为2组:观察组24例(采用双反牵引复位器复位), 对照组22例(采用牵引床复位), 两组均采用FNS固定。采集并比较两组患者手术时间、复位时间、透视次数、术中出血量、术后即刻及术后12个月股骨颈短缩程度、术后3、6、12个月患侧髋关节功能Harris评分及下肢静脉血栓发生率。结果两组患者在年龄、性别、骨折类型等方面差异均无统计学意义(P> 0.05), 具有可比性。观察组手术时间[57.5(54.0, 64.5) min]、复位时间[(16.3±3.0)min]和透视次数[(20.5±4.6)次]均显著少于对照组手术时间[85.0(71.3, 92.0)min]、复位时间[(21.0±6.0) min]和透视次数[(29.7±4.7)次], 差异均有统计学意义(P<0.05)。两组患者术中出血量差异无统计学意义(P>0.05)。所有患者术后获12~22个月(平均15.5个月)随访。术后即刻、术后12个月患者股骨颈短缩程度两组间比较差异均无统计学意义(P>0.05)。术后3个月观察组患侧髋关节Harris评分明显优于对照组, 差异有统计学意义(P<0.05), 但术后6、12个月两组髋关节Harris评分比较, 差异均无统计学意义(P>0.05)。观察组下肢静脉血栓发生率(12.5%, 3/24)显著低于对照组(40.9%, 9/22), 差异有统计学意义(P<0.05)。结论相较于牵引床, 双反牵引器辅助FNS复位固定股骨颈骨折具有操作更简单、花费时间更短、透视次数更少、早期髋关节功能恢复更好和血栓并发症发生率低等优点。

Objective To compare the clinical efficacy between a bidirectional-traction reduction device and a traction table in the treatment of femoral neck fracture with femoral neck system(FNS).Methods A retrospective study was conducted in the 46 patients with femoral neck fracture who had been treated at Department of Orthopedics,The First Central Hospital of Baoding from January 2020 to January 2021.There were 19 males and 27 females,aged from 30 to 64 years(average,47.1 years).According to the Garden classification,29 cases were typeⅢand 17 typeⅣ.By the reduction method,the patients were assigned into an observation group(n=24)in which the reduction was assisted by a bidirectional-traction reduction device and a control group(n=22)in which the reduction was assisted by a traction table.FNS fixation was conducted in both groups.The 2 groups were compared in terms of operation time,reduction time,fluoroscopy frequency,intraoperative blood loss,femoral neck shortening at immediate postoperation and 12 months postoperation,Harris scores of the affected hip at 3,6,and 12 months postoperation,and incidence of lower extremity venous thrombosis.Results There were no significant differences in age,gender or fracture type between the 2 groups,showing they were comparable(P>0.05).The observation group needed significantly less operation time[57.5(54.0,64.5)min],reduction time[(16.3±3.0)min]and fluoroscopy frequency[(20.5±4.6)times]than the control group did[85.0(71.3,92.0)min,(21.0±6.0)min and(29.7±4.7)times,respectively](all P<0.05).There was no significant difference in intraoperative blood loss between 2 groups(P>0.05).All patients were followed up for 12 to 22 months(average,15.5 months).There was no significant difference in femoral neck shortening between the 2 groups at immediate postoperation or 12 months postoperation(P>0.05).The Harris score of the affected hip in the observation group was significantly better than that in the control group at 3 months after surgery(P<0.05),but such a significant difference was not observed at 6 or 12 months postoperation(P>0.05).The incidence of thrombotic complications in the observation group(12.5%,3/24)was significantly lower than that in the control group(40.9%,9/22)(P<0.05).Conclusions In the FNS treatment of femoral neck fracture,compared with a traction table,reduction assisted by a bidirectional-traction reduction device is more advantageous because it is simpler and less time-consuming,incurs less fluoroscopy and leads to better early functional recovery of the affected hip and lower incidence of thrombotic complications.