F型钳辅助复位在股骨干骨折手术中的临床应用

F-type forceps for assisted reduction in femoral shaft fractures surgery

目的:探讨辅助复位工具F型钳在股骨干骨折复位中的临床疗效。方法:回顾性分析2019年1月至2021年12月采用髓内钉内固定手术治疗的45例股骨干骨折患者,根据复位方法不同分为两组。观察组21例,男15例,女6例;年龄27~92(53.38±18.81)岁;左侧9例,右侧12例;骨折AO分型,A型7例,B型8例,C型6例;受伤至手术时间7~13(4.62±3.34)d;采用F型钳辅助复位。对照组24例,男17例,女7例;年龄20~92(51.96±20.43)岁;左侧12例,右侧12例;骨折AO分型,A型11例,B型8例,C型5例;受伤至手术时间2~13(6.29±3.04)d;采用传统复位方式。比较两组手术时间、术中出血量、术中透视次数、术中切开复位比例、骨折临床愈合时间、术后并发症、住院时间、住院费用,并于术后6、12个月采用膝关节Lysholm评分进行临床疗效评价。结果:所有患者获得随访,时间12~24(16.60±3.45)个月。观察组手术时间、术中出血量、术中透视次数、切开复位例数、骨折临床愈合时间分别为(58.19±7.93)min、(88.10±44.45)ml、(25.29±5.54)次、0例、(4.76±0.77)个月,对照组分别为(79.33±22.94)min、(222.92±144.45)ml、(47.46±26.25)次、5例、(7.13±1.80)个月,两组比较差异有统计学意义(P<0.05)。两组术后并发症、住院时间及住院费用比较,差异无统计学意义(P>0.05)。术后6个月观察组膝关节Lysholm评分(88.62±4.48)分,优于对照组(79.21±8.91)分(F=21.948,P=0.000);两组术后6个月支撑物使用、疼痛、下蹲评分比较,差异无统计学意义(P>0.05)。术后12个月观察组膝关节Lysholm评分中爬楼梯、疼痛评分(9.62±1.20)、(19.76±1.92)分,优于对照组(7.83±2.04)、(21.88±2.88)分(P<0.05);两组其他项目评分及总分比较,差异无统计学意义(P>0.05)。结论:F型钳器械操作简单,易学易用,与传统的复位方法相比,在股骨干骨折复位中,能缩短手术时间,减少术中出血量,降低术中透视次数,加快骨折临床愈合,使膝关节获得更加早期的功能恢复。

Objective To explore clinical efficacy of F-type forceps for assisted reduction in femoral shaft fracture reduction.Methods Forty-five patients with femoral shaft fracture treated with intramedullary nail and internal fixation from January 2019 to December 2021 were retrospectively analyzed and divided into two groups according to different reduction methods.In observation group,there were 21 patients,included 15 males and 6 females,aged from 27 to 92 years old with an average of(53.38±18.81)years old;9 patients on the left side,12 patients on the right side;7 patients were type A,8 patients were type B and 6 patients were type C according to AO fracture classification;the time from injury to operation ranged from 7 to 13 days with an average of(4.62±3.34)days;reduction was assisted by F-shaped forceps.In control group,there were 24 patients,including 17 males and 7 females,aged from 20 to 92 years old with an average of(51.96±20.43)years old;12 patients on the left side,12 patients on the right side;11 patients were type A,8 patients were type B and 5 patients were type C according to AO fracture classification;the time from injury to operation ranged from 2 to 13 days with an average of(6.29±3.04)days;traditional reset mode was adopted.Operative time,intraoperative blood loss,intraoperative fluoroscopy times,intraoperative open reduction ratio,clinical healing time of fracture,postoperative complications,hospital stay,hospital cost and Lysholm score of knee joint at 6 and 12 months after surgery were compared between two groups to evaluate clinical effect.Results All patients were followed up for 12 to 24 months with an average of(16.60±3.45)months.In observation group,operative time,intraoperative blood loss,intraoperative fluoroscopy times,open reduction cases,and clinical healing time of fractures were(58.19±7.93)min,(88.10±44.45)ml,(25.29±5.54)times,0 case,(4.76±0.77)months,respectively;while in control group was(79.33±22.94)min,(222.92±144.45)ml,(47.46±26.25)times,5 cases,(7.13±1.80)months,and the difference between two groups were statistically significant(P<0.05).There were no significant difference in postoperative complications,length of stay and hospitalization cost between two groups(P>0.05).At 6 months after surgery,Lysholm score of knee joint in observation group(88.62±4.48)was better than that in control group(79.21±8.91)(F=21.948,P=0.000).There were no significant difference in support use,pain and squat score between two groups(P>0.05).At 12 months after surgery,Lysholm scores of stair climbing and pain in observation group were(9.62±1.20)and(19.76±1.92),which were better than those in control group(7.83±2.04)and(21.88±2.88)(P<0.05).There were no significant difference in scores and total scores of other items between two groups(P>0.05).Conclusion Compared with traditional reduction method,F-type forceps instrument could shorten operation time,reduce intraoperative blood loss,reduce intraoperative fluoroscopy times,accelerate clinical healing of fracture,and promote earlier functional recovery of knee joint.