| 先正确开口插髓内钉再复位治疗闭合复位困难的股骨转子间骨折 |
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投稿时间：2017-12-20
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| 作者 | Author | 单位 | Address | E-Mail |
| 郑旭欣 |
ZHENG Xu-xin |
金华市人民医院骨科, 浙江 金华 321000 |
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zjlxzxx@163.com |
| 徐胜余 |
XU Sheng-yu |
浙江省兰溪市中医院骨科, 浙江 兰溪 321100 |
Department of Orthopaedics, the People's Hospital of Jinhua, Jinhua 321100, Zhejiang, China |
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| 陈瑞芝 |
CHEN Rui-zhi |
浙江省兰溪市中医院骨科, 浙江 兰溪 321100 |
Department of Orthopaedics, the People's Hospital of Jinhua, Jinhua 321100, Zhejiang, China |
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| 俞鸣 |
YU Ming |
浙江省兰溪市中医院骨科, 浙江 兰溪 321100 |
Department of Orthopaedics, the People's Hospital of Jinhua, Jinhua 321100, Zhejiang, China |
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| 黄敬成 |
HUANG Jing-cheng |
浙江省兰溪市中医院骨科, 浙江 兰溪 321100 |
Department of Orthopaedics, the People's Hospital of Jinhua, Jinhua 321100, Zhejiang, China |
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| 姚卫兵 |
YAO Wei-bing |
浙江省兰溪市中医院骨科, 浙江 兰溪 321100 |
Department of Orthopaedics, the People's Hospital of Jinhua, Jinhua 321100, Zhejiang, China |
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| 邱波 |
QIU Bo |
浙江省兰溪市中医院骨科, 浙江 兰溪 321100 |
Department of Orthopaedics, the People's Hospital of Jinhua, Jinhua 321100, Zhejiang, China |
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| 期刊信息：《中国骨伤》2018年，第31卷，第5期，第400-407页 |
| DOI：10.3969/j.issn.1003-0034.2018.05.002 |
| 基金项目: |
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中文摘要:
目的：比较先正确开口插髓内钉再复位手术方法和传统复位手术方法治疗闭合复位困难的不稳定型股骨转子间骨折的临床疗效。
方法：回顾性分析2013年1月至2016年6月采用先正确开口插髓内钉再复位手术方法和传统复位手术方法治疗闭合复位困难的不稳定型股骨转子间骨折（AO 31A2.2-3.3），且随访超过12个月的58例患者。其中32例采用先正确开口插髓内钉再复位手术方法治疗（改良复位组），男9例，女23例；年龄46~99岁，平均（80.9±11.1）岁。26例采用传统复位手术方法治疗（传统复位组），男7例，女19例；年龄41~89岁，平均（78.1±13.9）岁。比较两组患者的手术时间、出血量、住院时间、首次负重时间、骨折愈合时间及术后并发症发生率，并采用Harris髋关节评分标准进行疗效评价。
结果：所有患者获得随访，时间12~24个月，平均17.3个月。改良复位组手术时间（t=3.612，P=0.008 2）和失血量（t=3.389，P=0.007 5）均低于传统复位组；两组住院时间（t=0.851，P=0.392）和骨折愈合时间（t=0.640，P=0.531）以及首次负重时间（t=0.845，P=0.411）差异无统计学意义。两组Harris评分疗效比较差异无统计学意义（χ2=0.66 P=0.831>0.05）。
结论：股骨转子间骨折传统复位方法要求骨折端先复位、有正确的开口扩髓，才能进行髓内钉的插入固定；但在复位困难的不稳定型股骨转子间骨折治疗过程中，操作繁琐；而先正确开口插髓内钉再复位方法可以正确开口扩髓，先插入髓内钉，再行骨折端的复位，操作简单，缩短了手术时间，减少了术中出血。 |
| 【关键词】股骨 髋骨折 骨折切开复位 |
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| Precise-surgical-opening intramedullary nail insertion in treating unstable femoral intertrochanteric fractures with closed-reposition difficulty |
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ABSTRACT
Objective: To compare clinical efficacy of repositioning with precise-surgical-opening intramedullary nail insertion and traditional repositioning in treating unstable femoral intertrochanteric fractures with closed-reposition difficulty.
Methods: Clinical data of 58 patients with unstable femoral intertrochanteric fractures after closed-reposition difficulty (AO 31A2.2-3.3) were retrospective analyzed. Among them, 32 patients were treated with first open intramedullary nail and then reduction operation (modified reductuon group) including 9 males and 23 females with an average age of (80.9±11.1) years old ranging from 46 to 99 years old; and 26 patients were treated by traditional reduction (traditional reduction group) including 7 males and 19 females with an average of (78.1±13.9) years old ranging from 41 to 89 years old. The time of operation, the amount of bleeding, the length of hospital stay, the first weight-bearing time and the time of fracture healing, postoperative complications and Harris hip score were evaluated and compared between the two groups.
Results: All patients were followed up for 12 to 24 months with an average of 17.3 months. The operative time (t=3.612, P=0.008 2)and the blood loss (t=3.389, P=0.007 5) in the modified reduction group were lower than those in the traditional reduction group. There were no significant differences in hospitalization time (t=0.851, P=0.392), fracture healing time (t=0.640, P=0.531), and the first loading time (t=0.845, P=0.411) between two groups. There was no significant difference in the Harris score between two groups (χ2=0.66, P=0.831>0.05).
Conclusion: Traditional repositioning requires a repositioning of the fracture bone and a correct opening reaming before the insertion and fixture of the intramedullary nail, which is a complicated operation in unstable femoral intertrochanteric fractures after closed-reposition difficulty. On the other hand, the new method implements the insertion of the intramedullary nail before the repositioning of the fracture bone, greatly simplifying the operation procedure, shortening the total operation time and reducing the amount of intraoperative blood loss. |
| KEY WORDS Femur Hip fractures Open fracture reduction |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 郑旭欣,徐胜余,陈瑞芝,俞鸣,黄敬成,姚卫兵,邱波.先正确开口插髓内钉再复位治疗闭合复位困难的股骨转子间骨折[J].中国骨伤,2018,31(5):400~407 |
| 英文格式: | ZHENG Xu-xin,XU Sheng-yu,CHEN Rui-zhi,YU Ming,HUANG Jing-cheng,YAO Wei-bing,QIU Bo.Precise-surgical-opening intramedullary nail insertion in treating unstable femoral intertrochanteric fractures with closed-reposition difficulty[J].zhongguo gu shang / China J Orthop Trauma ,2018,31(5):400~407 |
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