Department of Orthopaedics, Affiliated Hospital of Putian University, Putian, China.
Operating Room, Affiliated Hospital of Putian University, Putian, China.
Orthop Surg. 2022 Oct;14(10):2750-2756. doi: 10.1111/os.13447. Epub 2022 Sep 2.
To investigate the feasibility of pre-drilling combined with a finger reduction tool for the reduction of difficult-to-reduce intertrochanteric fractures.
Patients diagnosed with complicated intertrochanteric fractures during the period from July 2016 to May 2021 at the Affiliated Hospital of our College were enrolled in this study. All patients underwent reduction by pre-drilling combined with a finger reduction tool followed by fixing with proximal femoral nail antirotation. The outcome of reduction was evaluated by intraoperative fluoroscopy. The operation time, intraoperative fluoroscopy frequency, and incidence of postoperative complications (including infection in the incision area, coxa vara, nail withdrawal, nail breakage, blade cut-out, lower limb vein thrombosis, and pulmonary embolism) were recorded to evaluate the speed of the operation, the difficulty of the operation, and the prognosis of the patient, respectively. The Harris hip score at 9 months after surgery was used to evaluate the hip recovery.
A total of 52 patients (17 men and 35 women), 61-88 (77.54 ± 7.40) years of age were included in the study. There were 14 patients with cardiovascular or cerebrovascular disease, ten patients with diabetes, three patients with Parkinson's disease, and three patients with respiratory diseases. The fractures included in the study were classified according to the Orthopedic Trauma Association 31 classification system as type A2.2 (n = 36) or type A2.3 (n = 16). The time from injury to surgery was 1-11 (3.35 ± 1.78) days, and the operation time ranged 31-101 (65.67 ± 14.17) min. The intraoperative blood loss ranged from 40 to 100 (67.69 ± 18.24) mL, and the number of intraoperative fluoroscopy images obtained was 12 to 32 (20.42 ± 5.27). The Harris hip score at 9 months after surgery ranged from 84 to 94 (90.06 ± 2.15). Patients were followed for 9-16 (10.63 ± 1.61) months. One patient died of acute myocardial infarction at 9 months after surgery. One patient suffered from nail withdrawal 5 months post-operation and thus underwent hemiarthroplasty.
Satisfactory reduction can be achieved using a pre-drilling femoral trochanter combined with a finger reduction tool for the management of difficult-to-reduce complex intertrochanteric fractures. This technique does not increase surgical trauma and also reduces the dose of radiation administered to the patient.
探讨预钻孔联合指骨复位工具在难复性股骨转子间骨折复位中的应用可行性。
回顾性分析 2016 年 7 月至 2021 年 5 月在我院接受治疗的复杂股骨转子间骨折患者，所有患者均采用预钻孔联合指骨复位工具复位，再使用股骨近端防旋髓内钉固定。术中透视评估复位效果，记录手术时间、术中透视次数及术后并发症（包括切口区感染、髋内翻、钉拔出、钉断裂、刀片切出、下肢静脉血栓形成、肺栓塞）发生情况，以评估手术速度、手术难度及患者预后。术后 9 个月采用 Harris 髋关节评分评估髋关节恢复情况。
共纳入 52 例患者（男 17 例，女 35 例），年龄 61-88 岁，平均（77.54±7.40）岁。其中合并心脑血管疾病 14 例、糖尿病 10 例、帕金森病 3 例、呼吸系统疾病 3 例。骨折按 Orthopedic Trauma Association 31 分型系统分为 A2.2 型（36 例）和 A2.3 型（16 例）。伤后至手术时间为 1-11 天，平均（3.35±1.78）天，手术时间为 31-101 分钟，平均（65.67±14.17）分钟。术中出血量为 40-100 毫升，平均（67.69±18.24）毫升，术中透视图像数为 12-32 张，平均（20.42±5.27）张。术后 9 个月 Harris 髋关节评分为 84-94 分，平均（90.06±2.15）分。患者均获随访，随访时间 9-16 个月，平均（10.63±1.61）个月。术后 9 个月 1 例死于急性心肌梗死，术后 5 个月 1 例发生钉拔出，改行人工股骨头置换术。
预钻孔联合指骨复位工具可满意复位治疗难复性复杂股骨转子间骨折，该技术不增加手术创伤，且降低患者的辐射剂量。
