Seyhan Mustafa, Unay Koray, Sener Nadir
Department of Orthopedics and Traumatology, Acıbadem Kadıköy Hospital, İstanbul, Turkey.
Acta Orthop Traumatol Turc. 2012;46(2):113-9. doi: 10.3944/AOTT.2012.2639.
The aim of this study was to compare the outcomes of three reduction methods used during intramedullary nailing of the subtrochanteric femur fractures.
This study included 45 patients with subtrochanteric femur fractures who were treated with intramedullary nailing. Twenty-two patients underwent clamp-assisted reduction, 11 reduction with cable cerclage, and 12 with blocking screws. Reduction techniques were compared with respect to the early postoperative alignment, one year postoperative alignment, time to full weight-bearing, time to union, Harris hip score at one year, operation and fluoroscopy times, blood transfusion amount, complications, and additional interventions.
The clamp-assisted reduction group had a statistically high mean time to full weight-bearing (p=0.038) and a low mean Harris hip score at one year (p=0.002). The blocking screw group's operation times and fluoroscopy times were statistically long. There was no statistically significant difference between the clamp-assisted reduction and cable cerclage groups in terms of operation times and fluoroscopy times. On the other hand, there were statistically significant differences between the clamp-assisted reduction and blocking screw groups (p=0.0001 and p=0.0001, respectively) and between the cable cerclage and blocking screw groups (p=0.037 p=0.0001, respectively) in terms of operation times and fluoroscopy times. There was no statistically significant difference between the clamp-assisted reduction, cable cerclage and the blocking screw groups in terms of early postoperative alignment, one year postoperative alignment, time to union, complications or additional interventions.
Clamp-assisted reduction leads to a longer time to weight-bearing and a poorer functional status at one year. Operation time and fluoroscopy time were longest in the blocking screw group.
本研究旨在比较股骨转子下骨折髓内钉固定时三种复位方法的效果。
本研究纳入45例接受髓内钉固定治疗的股骨转子下骨折患者。22例患者接受钳夹辅助复位，11例采用缆绳环扎复位，12例采用阻挡螺钉复位。比较三种复位技术在术后早期对线、术后一年对线、完全负重时间、骨折愈合时间、一年时的Harris髋关节评分、手术及透视时间、输血量、并发症及额外干预情况。
钳夹辅助复位组完全负重的平均时间在统计学上较长（p = 0.038），且一年时的平均Harris髋关节评分较低（p = 0.002）。阻挡螺钉组的手术时间和透视时间在统计学上较长。钳夹辅助复位组与缆绳环扎组在手术时间和透视时间方面无统计学显著差异。另一方面，钳夹辅助复位组与阻挡螺钉组在手术时间和透视时间方面存在统计学显著差异（分别为p = 0.0001和p = 0.0001），缆绳环扎组与阻挡螺钉组在手术时间和透视时间方面也存在统计学显著差异（分别为p = 0.037和p = 0.0001）。钳夹辅助复位组、缆绳环扎组和阻挡螺钉组在术后早期对线、术后一年对线、骨折愈合时间、并发症或额外干预方面无统计学显著差异。
钳夹辅助复位导致负重时间延长且一年时功能状态较差。阻挡螺钉组的手术时间和透视时间最长。
