皮肤标记指引股骨髓内导针置入在治疗股骨转子间骨折中的应用

The application of skin lineation guided femoral intramedullary vectoring needle placement in the treatment of femoral intertrochanteric fracture

目的总结皮肤标记指引股骨髓内导针置入在闭合复位髓内固定术治疗股骨转子间骨折中的应用效果。方法将50例股骨转子间骨折患者根据随机数字表法分为观察组(采用皮肤标记指引股骨髓内导针置入治疗,25例)和对照组(采用传统触摸方法置入股骨髓内导针治疗,25例)。记录手术情况、骨折复位及愈合情况,术后3个月采用Harris评分评价髋关节功能。结果患者均获得随访,时间3~12个月。切口长度、手术时间、术中出血量、透视时间观察组均短(少)于对照组(P<0.05)。术后X线片显示:15例骨折断端对位、对线良好,达到解剖复位标准;35例存在骨折端轻度移位,无明显成角、旋转、短缩畸形,达到功能复位要求。两组骨痂形成时间6~12周,骨折愈合时间11~20周。术后3个月Harris评分两组比较差异无统计学意义(P>0.05)。结论皮肤标记指引股骨髓内导针置入应用于闭合复位髓内固定术治疗股骨转子间骨折中,可缩短切口长度、手术时间、透视时间,减少术中出血量。

Objective To summarize the application effect of skin lineation guided femoral intramedullary vectoring needle placement in the treatment of the intertrochanteric fractures.Methods The 50 patients with intertrochanteric fractures were divided into observation and control group two groups,according the random numbeRtable method,they were all treated with the intramedullary needle,of which 25 cases in the observation group were guided with the precise positioning method on the skin lineation,while 25 cases in the control group were treated with conventional touch method.The surgery conditions,the situation of fracture reduction and fracture healing were recorded,and Harris score was used to evaluate the hip joint function at 3 months postoperation.Results All patients were followed up foR3~12 months.The incision length,operation time,intraoperative blood loss and fluoroscopy time in the observation group were all shorter(less)than those in the control group(P<0.05).The X-ray film confirmed that 15 cases reached the anatomical reduction standard,with good aligment of fracture end and good aligment,35 cases had slight displactment of the fracture end,without obvious angulation,rotation oRshortening deformity,which met the requirements of functional reduction.The time of callus formation was 6~12 weeks afteRoperation,and all fractures healed in 11~20 weeks.At 3 months postoperation,Harris scores had statistical difference between two groups(P<0.05).Conclusions Skin lineation guided femoral intramedullary vectoring needle insertion during closed reduction and intramedullary fixation of intertrochanteric fracture can significantly shorten the incision lengthen,operation duration and the fluoroscopy time,reduce intratoperative blood loss.