摘要
目的设计股骨小转子复位固定器,并通过临床应用验证其应用价值及疗效。方法根据股骨转子间骨折的临床解剖特点,设计制作股骨小转子复位固定器。2010年1月-2012年7月,纳入符合选择标准的66例EvansⅢ型股骨转子间骨折患者。将患者随机分为两组,试验组32例在动力髋螺钉（dynamic hip screw,DHS）治疗基础上,使用股骨小转子复位固定器对小转子进行固定;对照组34例仅单纯行DHS固定治疗。两组患者性别、年龄、致伤原因及骨折类型等一般资料比较,差异均无统计学意义（P〉0.05）,具有可比性。比较两组手术时间、术中出血量、术后股骨颈干角、骨折愈合时间、固定成功率及Harris髋关节功能评分。结果试验组手术时间及术中出血量[（58.4±5.3）min和（186.3±6.6）mL]均显著少于对照组[（78.5±6.2）min和（246.2±8.7）mL]（t=—14.040,P=0.000;t=—31.145,P=0.000）;两组术后股骨颈干角[试验组（138.6±3.0）°和对照组（139.4±2.9）°]比较差异无统计学意义（t=—1.044,P=0.301）。两组手术切口均Ⅰ期愈合。试验组30例获随访,随访时间12-24个月,平均15个月;对照组31例获随访,随访时间13-25个月,平均16个月。两组骨折均顺利愈合,试验组骨折愈合时间[（8.8±2.0）周]显著少于对照组[（10.7±3.4）周]（t=—2.871,P=0.006）。术后12个月试验组和对照组固定成功率分别为93.3%（28/30）和67.7%（21/31）,比较差异有统计学意义（χ^2=6.319,P=0.022）。试验组和对照组Harris髋关节功能评分优良率分别为83.3%（25/30）和58.1%（18/31）,差异有统计学意义（χ^2=4.680,P=0.049）。结论对于股骨转子间骨折,在DHS固定基础上应用股骨小转子复位固定器,可减少骨折块周围软组织剥离,缩短手术及骨折愈合时间,最大限度地保存髋关节功能。
Objective To design and produce a lesser trochanteric reduction fixation system and verify its value and effectiveness. Methods A lesser trochanteric reduction fixation system was designed and produced according to the anatomical features of the lesser trochanteric fractures. Sixty-six patients with intertrochanteric fractures of Evans type Ⅲ were included between January 2010 and July 2012. Of 66 patients, 32 were treated with dynamic hip screw（DHS） assisted with the lesser trochanteric reduction fixation system（study group）, and 34 cases were treated with DHS only（control group）. The 2 groups were comparable with no significant difference in gender, age, the reasons, and the types of the fractures（P〉0.05）. The operation time, intraoperative blood loss, neck-shaft angle, bone healing time, ratio of successful fixations, and the functional evaluation of the hip joint after operation were compared between 2 groups. Results The study group had shorter operation time [（58.4±5.3） minutes] and less intraoperative blood loss [（186.3±6.6） m L] than the control group[（78.5±6.2）minutes and（246.2±8.7） mL], showing significant differences（t=—14.040, P=0.000; t=—31.145, P=0.000）. There was no significant difference in neck-shaft angle between study group [（138.6±3.0）°] and control group [（139.4±2.9）°]（t=—1.044, P=0.301）. The wounds healed by first intention in both groups. The 30 and 31 patients were followed up 12 to 24 months（mean, 15 months） in the study group, and 13 to 25 months（mean, 16 months） in the control group, respectively. All fractures healed well in 2 groups. The study group had significantly shorter healing time[（8.8±2.0） weeks] than the control group [（10.7±3.4） weeks]（t=—2.871, P=0.006）. At 12 months after operation, coxa vara happened in 2 cases of the study group with a successful fixation ratio of 93.3% and in 10 cases of the control group with a successful fixation ratio of 67.7%, showing significant difference（χ^2=6.319, P=0.022）. According to Harris hip score, the excellent and good rate was 83.3% in the study group（25/30） and was 58.1% in the control group（18/31）, showing significant difference（χ^2=4.680, P=0.049）. Conclusion The application of the lesser trochanteric reduction fixation system can reduce stripping of the soft tissue around the fracture fragments, shorten the operation time and the healing time, and preserve the function of the hip joint maximumly.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2015年第2期133-137,共5页
Chinese Journal of Reparative and Reconstructive Surgery
基金
广东省科技计划项目(2012B060100008)~~
关键词
股骨小转子复位固定器
股骨转子间骨折
动力髋螺钉
内固定
Lesser trochanteric reduction fixation system
Intertrochanteric fracture
Dynamic hip screw
Internal fixation
