微创双通道技术治疗老年ⅠA型难复性股骨转子间骨折

Dual-channel minimally invasive surgery for treatment of irreducible ⅠA intertrochanteric fracture in elderly patients

目的 探讨微创双通道技术治疗老年ⅠA型难复性股骨转子间骨折疗效。方法 回顾性分析2016年8月—2020年6月于江苏省宜兴市人民医院行微创双通道治疗老年ⅠA型难复性股骨转子间骨折患者52例,与同时期采用三通道治疗此类骨折患者82例进行对照,对比两组患者骨折复位时间、手术时间、术中出血量、术后髋部疼痛评分、术后超敏C反应蛋白水平、骨折复位质量、骨折愈合时间及相关并发症等。结果 两组患者术前一般资料差异无统计学意义(P>0.05)。与三通道组患者相比,双通道组患者术中复位时间及总复位时间均较短[(3.40±1.05) min vs(6.09±0.84) min,P<0.001;(10.96±1.87) min vs(13.74±1.90) min,P<0.001]。双通道组患者手术时间较短[(53.62±8.99) min vs(68.35±5.29) min,P<0.001],术中出血量较少[(122.54±21.23) mL vs(146.43±31.02) mL,P<0.001],术后髋部疼痛评分较低(2.83±0.83 vs 3.30±1.09,P=0.008),术后超敏C反应蛋白水平较低[(19.33±5.87) mg/L vs(26.12±7.39) mg/L,P<0.001]。两组患者在切皮前闭合复位时间、内固定方式、骨折复位质量、骨折愈合时间及并发症方面均无统计学意义(P>0.05)。结论 采用微创双通道技术治疗老年ⅠA型难复性股骨转子间骨折可缩短手术时间,减少术中出血,并且可以减轻术后局部炎症反应,减轻术后髋部疼痛,有利于患者术后快速康复。

Objective To evaluation the efficacy of dual-channel minimally invasive surgery in the treatment of irreducible ⅠA intertrochanteric fracture for elderly patients. Methods Clinical data of 52 elderly patients with irreducible ⅠA intertrochanteric fracture who received dual-channel minimally invasive surgery in our hospital from August 2016 to June 2020 were retrospectively analyzed;the clinical outcomes were compared with 82 patients who received three-channel treatment in the same period. The fracture reduction time, operation time, intraoperative blood loss, postoperative hip pain score, postoperative hypersensitive C-reactive protein(hs-CRP) level, fracture reduction quality, fracture healing time and related complications were compared between the two groups. Results There was no significant difference in preoperative general data between the two groups(P>0.05). Compared with the three-channel group, the two-channel group had shorter intraoperative reduction time and total reduction time [(3.40±1.05) min vs(6.09±0.84) min, P<0.001;(10.96±1.87) min vs(13.74±1.90) min, P<0.001];the dual-channel group had shorter operation time [(53.62±8.99) min vs(68.35±5.29) min, P<0.001] and less intraoperative blood loss [(122.54±21.23) mL vs(146.43±31.02) mL, P<0.001]. Postoperative hip pain score in dual-channel group was lower(2.83±0.83 vs 3.30±1.09, P=0.008), and postoperative hs-CRP level was lower [(19.33±5.87) mg/L vs(26.12±7.39) mg/L, P<0.001]. There were no significant differences in closed reduction time, implant options, fracture reduction quality, fracture healing time and complications between two groups(P>0.05). Conclusion The minimally invasive dual-channel technique for the treatment of irreducible ⅠA intertrochanteric fracture in the elderly patients can shorten the operation time, reduce intraoperative bleeding, alleviate postoperative local inflammatory reaction, relieve postoperative hip pain, and benefit patients with rapid postoperative recovery.