Jiang Tao, Gao Han, Liu Tao, Kang Shijie, Bao Feilong, Huang Dongsheng, Hu Yiming
Department of Orthopedic Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China.
Department of Pathology, Qingdao Municipal Hospital, Qingdao, China.
Ann Transl Med. 2022 Aug;10(15):822. doi: 10.21037/atm-22-2846.
There are few reports on the efficacy and safety of percutaneous lever reduction combined with intramedullary nailing in the treatment of irreducible functional intertrochanteric fracture. This study was designed to investigate the clinical effect of percutaneous reduction by leverage combined with intramedullary nail internal fixation in the treatment of irreducible femoral intertrochanteric fracture.
A total of 26 patients with irreducible femoral intertrochanteric fracture admitted to Qilu Hospital were included in this study, including 10 males and 16 females. All fractures were reduced through an incision made at the insertion point of the intramedullary nail head or the main nail with the aid of auxiliary equipment such as a periosteal dissector or a bone-holding forcep. Indicators such as operative time, blood loss, and complications were recorded, and the quality of fracture reduction was evaluated by the Baumgaetner modified method. All the patients were followed up regularly for 3 months, 1 year, and 2 years postoperatively, and the Zuckerman Functional Recovery Scale (FRS) for Hip Fracture was utilized to evaluate the hip function of the patients. The Euro-Quality of Life-5 Dimension (EQ-5D) was used to evaluate the quality of life of patients. Hip pain was assessed by the visual analog scale (VAS) at the last follow-up.
According to the Evans-Jensen classification of fractures, 12 cases were classified as type III, 10 as type IV, and 4 as type V. The mean operation time was 67.9±16.4 min and the intraoperative blood loss was 165.8±58.3 mL. All fractures healed completely. In terms of fracture reduction quality, 14 cases were excellent and 11 cases were good. At the last follow-up, the FRS scores decreased from 93.3±5.7 preoperatively to 81.5±18.5 postoperatively, and the EQ-5D index decreased from 0.95±0.05 preoperatively to 0.86±0.14 postoperatively.
With mini-incision assisted reduction combined with intramedullary nail internal fixation to treat of irreducible femoral intertrochanteric fracture, favorable clinical results can be obtained, and the walking ability and quality of life of the patients can be improved postoperatively.
关于经皮杠杆复位联合髓内钉治疗难复性功能性粗隆间骨折的疗效及安全性的报道较少。本研究旨在探讨经皮杠杆复位联合髓内钉内固定治疗难复性股骨粗隆间骨折的临床效果。
本研究纳入齐鲁医院收治的26例难复性股骨粗隆间骨折患者，其中男性10例，女性16例。所有骨折均在髓内钉头部或主钉插入点处做切口，借助骨膜剥离器或持骨钳等辅助设备进行复位。记录手术时间、出血量及并发症等指标，采用Baumgaetner改良法评估骨折复位质量。所有患者术后定期随访3个月、1年和2年，采用髋部骨折的Zuckerman功能恢复量表（FRS）评估患者的髋关节功能，采用欧洲五维健康量表（EQ-5D）评估患者的生活质量。末次随访时采用视觉模拟评分法（VAS）评估髋部疼痛情况。
根据Evans-Jensen骨折分类，Ⅲ型12例，Ⅳ型10例，Ⅴ型4例。平均手术时间为67.9±16.4分钟，术中出血量为165.8±58.3毫升。所有骨折均完全愈合。在骨折复位质量方面，优14例，良11例。末次随访时，FRS评分从术前的93.3±5.7降至术后的81.5±18.5，EQ-5D指数从术前的0.95±0.05降至术后的0.86±0.14。
采用小切口辅助复位联合髓内钉内固定治疗难复性股骨粗隆间骨折，可获得良好的临床效果，术后可改善患者的行走能力及生活质量。
