Cao Faqi, Xie Xudong, Hu Yiqiang, Zhou Wu, Mi Bobin, Liu Mengfei, Liu Guohui
Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Ann Transl Med. 2022 Oct;10(19):1071. doi: 10.21037/atm-22-4658.
Currently, we found that double reverse traction repositor (DRTR) is a treatment with operation convenience and fast in our clinical work. However, the clinical efficacy and safety of DRTR in the reduction of unstable intertrochanteric fractures in elderly patients remain unknown. Therefore, the study aimed to compare the clinical efficacy and safety of DRTR and traction table (TT) in the reduction of unstable intertrochanteric fractures in elderly patients.
From October 2018 to December 2020, the elderly patients with unstable intertrochanteric fractures were reviewed. 22 patients treated with TT and 20 patients treated with DRTR met the inclusion criteria of this study, and baseline clinical characteristics were recorded. The reduction time, operation time, incision length and intraoperative blood loss were reviewed. The safety outcome was assessed by postoperative complications, and the efficacy outcomes were evaluated by the fracture healing time based on the radiographs conducted at each follow-up (1, 3, 6, 12 months after surgery) and hip function (hip flexion, Harris Hip Score) at the final follow-up (12 months after surgery).
There were no significant differences in terms of demographics and fracture characteristics of cases enrolled. In DRTR group, the average intraoperative reduction time [(34.8±7.6) min] and the average operation time [(87.1±12.2) min] were superior to those [(56.6±9.3); (123.1±15.0) min] in TT group (P<0.0001). However, there were no statistical significance in terms of the average incision lengths [(6.4±0.9) . (6.8±1.1) cm; P=0.1619], , the average intraoperative blood loss [(152.6±22.9) . (146.8±20.7) mL; P=0.3941], the average fracture healing times [(13.8±1.5) . (14.4±1.8) weeks; P=0.2350] and the average Harris hip score a year after operation [(84.4±6.6) . (82.7±7.2); P=0.4496] between the two groups. One patient in TT group experienced lower extremity intermuscular venous thrombosis postoperatively. No other operation-related complications were observed postoperatively nor during follow-up.
Minimally invasive reduction with DRTR in unstable intertrochanteric fractures could effectively shorten the intraoperative reduction time and operation time in this study. Therefore, minimally invasive reduction with DRTR might be a good choice for intertrochanteric reduction of unstable intertrochanteric fractures.
目前，我们发现在临床工作中双反牵引复位器（DRTR）是一种操作简便且快速的治疗方法。然而，DRTR治疗老年患者不稳定型股骨转子间骨折的临床疗效和安全性尚不清楚。因此，本研究旨在比较DRTR与牵引床（TT）治疗老年患者不稳定型股骨转子间骨折的临床疗效和安全性。
回顾2018年10月至2020年12月期间老年不稳定型股骨转子间骨折患者。22例接受TT治疗的患者和20例接受DRTR治疗的患者符合本研究的纳入标准，并记录其基线临床特征。回顾复位时间、手术时间、切口长度和术中出血量。通过术后并发症评估安全性结果，通过每次随访（术后1、3、6、12个月）拍摄的X线片评估骨折愈合时间，并在最终随访（术后12个月）时评估髋关节功能（髋关节屈曲、Harris髋关节评分）来评估疗效结果。
纳入病例的人口统计学和骨折特征方面无显著差异。DRTR组的平均术中复位时间[（34.8±7.6）分钟]和平均手术时间[（87.1±12.2）分钟]优于TT组[（56.6±9.3）；（123.1±15.0）分钟]（P<0.0001）。然而，两组在平均切口长度[（6.4±0.9）.（6.8±1.1）厘米；P=0.1619]、平均术中出血量[（152.6±22.9）.（146.8±20.7）毫升；P=0.3941]、平均骨折愈合时间[（13.8±1.5）.（14.4±1.8）周；P=0.2350]以及术后一年的平均Harris髋关节评分[（84.4±6.6）.（82.7±7.2）；P=0.4496]方面无统计学差异。TT组有1例患者术后发生下肢肌间静脉血栓形成。术后及随访期间未观察到其他与手术相关的并发症。
本研究中，使用DRTR对不稳定型股骨转子间骨折进行微创复位可有效缩短术中复位时间和手术时间。因此，使用DRTR进行微创复位可能是不稳定型股骨转子间骨折转子间复位的一个不错选择。
