G臂X线机透视下采用折顶技术联合直角钳撬拉治疗老年难复性股骨转子间骨折

Treatment of irreducible intertrochanteric femoral fracture in elderly by folding top technique combined with right-angle pliers prying and pulling under G-arm X-ray fluoroscopy

目的探讨在G臂X线机透视下采用折顶技术联合直角钳撬拉辅助复位治疗老年难复性股骨转子间骨折的临床疗效。方法回顾分析2016年2月—2022年12月收治且符合选择标准的74例老年难复性股骨转子间骨折患者临床资料。其中38例术中应用折顶技术联合直角钳撬拉进行复位并髓内钉固定(研究组),36例术中应用有限切开复位联合其他复位方法并髓内钉固定(对照组)。两组患者年龄、性别、致伤原因、骨折侧别及分型、合并内科疾病、受伤至手术时间等基线资料比较,差异均无统计学意义(P>0.05)。记录并比较两组患者手术时间、术中出血量、住院时间、骨折复位时间、骨折愈合时间及并发症发生情况;以Baumgaertner等及张世民等的骨折复位标准评定骨折复位质量。结果两组患者均获随访,随访时间10~14个月,平均12个月。研究组手术时间、术中出血量均少于对照组,差异有统计学意义(P<0.05);两组住院时间比较差异无统计学意义(P>0.05)。术后2 d根据Baumgaertner等及Chang等的骨折复位标准评定骨折复位质量,研究组均优于对照组,且研究组骨折复位时间亦明显短于对照组,差异均有统计学意义(P<0.05)。术后两组患者骨折均愈合,愈合时间比较差异无统计学意义(P>0.05)。随访期间除对照组2例发生髋内翻畸形外,两组其余患者术后均无切口感染、内固定失效、下肢深静脉血栓形成以及髓内钉断裂、螺旋刀片切割、髋内翻等并发症发生。结论对于老年难复性股骨转子间骨折,采用G臂X线机透视下折顶技术联合直角钳撬拉辅助复位治疗,可明显缩短手术时间、减少术中出血量、提高骨折复位质量。

Objective To explore the effectiveness of irreducible intertrochanteric femoral fracture in the elderly by treating with folding top technique and right-angle pliers prying and pulling under G-arm X-ray fluoroscopy.Methods The clinical data of 74 elderly patients with irreducible intertrochanteric femoral fracture admitted between February 2016 and December 2022 and met the selection criteria were retrospectively analyzed.Among them,38 cases were treated with folding top technique combined with right-angle pliers prying and pulling under G-arm X-ray fluoroscopy and intramedullary nailing fixation(study group),and 36 cases were treated with limited open reduction combined with other reduction methods and intramedullary nailing fixation(control group).There was no significant difference in baseline data between the two groups,such as age,gender,cause of injury,affected side and classification of fractures,complicated medical diseases,and time from injury to operation(P>0.05).The operation time,intraoperative blood loss,hospital stay,fracture reduction time,fracture healing time,and complications of the two groups were recorded and compared.The quality of fracture reduction was evaluated by Baumgaertner et al.and Chang et al.fracture reduction standards.Results Patients in both groups were followed up 10-14 months,with an average of 12 months.The operation time and intraoperative blood loss in the study group were significantly less than those in the control group(P<0.05),there was no significant difference in hospital stay between the two groups(P>0.05).At 2 days after operation,according to the fracture reduction standards of Baumgaertner et al.and CHANG Shimin et al.,the quality of fracture reduction in the study group was better than that in the control group,and the fracture reduction time in the study group was shorter than that in the control group,with significant differences(P<0.05).After operation,the fractures of the two groups all healed,and there was no significant difference in healing time between the two groups(P>0.05).During the follow-up,there was no complication such as incision infection,internal fixation failure,deep venous thrombosis of lower limbs,intramedullary nail breakage,spiral blade cutting,or hip varus in the two groups,except for 2 cases of coxa vara in the control group.Conclusion For the irreducible intertrochanteric femoral fracture,using folding top technique combined with right-angle pliers prying and pulling under G-arm X-ray fluoroscopy can obviously shorten the operation time,reduce the intraoperative blood loss,and improve the quality of fracture reduction.