InterTan髓内钉固定治疗难复性老年股骨转子间骨折中小切口辅助撬拨复位时机的选择OA
Selection of timing of small incision assisted prying reduction with InterTan intramedullary nail fixation on the irreducible elderly intertrochanteric femoral fracture
目的 探讨 InterTan 髓内钉固定治疗难复性老年股骨转子间骨折中小切口辅助撬拨复位时机的选择.方法 将 82 例难复性老年股骨转子间骨折患者根据术中撬拨复位时机的不同分为 A 组(术中 3～5 次手法闭合复位失败后行小切口辅助撬拨复位,41 例)和 B 组(术中首次手法闭合复位失败后即行小切口辅助撬拨复位,41 例).比较两组麻醉时间、手术时间、骨折复位质量、骨折愈合时间、术后并发症发生情况及炎症指标,采用 Harris 评分评价髋关节功能.结果 患者均获得随访,时间 12～24 个月.术后 X 线复查显示骨折均达解剖复位.麻醉时间、手术时间、术后 1d 白细胞介素-6B 组均短(低)于 A 组(P＜0.01);术后 1d 白细胞计数、骨折愈合时间两组比较差异均无统计学意义(P＞0.05).两组术后均无切口感染、内固定失效等并发症发生.末次随访时 Harris 评分两组比较差异无统计学意义(P＞0.05).结论 采用 InterTan 髓内钉固定治疗难复性老年股骨转子间骨折时,首次闭合复位失败后即行小切口辅助撬拨复位可有效缩短麻醉时间及手术时间,减少麻醉药物用量,同时能抑制炎症反应,降低围手术期风险,提高治疗安全性.
Objective To investigate the selection of timing of small incision assisted prying reduction with InterTan intramedullary nail fixation in the treatment of irreducible elderly intertrochanteric femoral fracture.Methods The 82 elderly patients with irreducible intertrochanteric femoral fractures were divided into Group A(The 41 cases were per-formed with small incision assisted prying reduction after failure of 3-5 times of intraoperative closed manual reduc-tion)and Group B(The 41 cases were performed with small incision assisted prying reduction immediately after the first failure of closed manual reduction).The anesthesia time,operation time,fracture reduction quality,incidence of postoperative complications,and inflammatory indicators were compared between the two groups.Hip joint function was evaluated using the Harris hip score.Results All patients were followed up for 12-24 months.Postoperative X-ray reexamination showed that all fractures achieved anatomical reduction.The anesthesia time,operation time,and post-operative 1d of interleukin-6 levels in Group B were all shorter(lower)than those in Group A(P＜0.01);there were no statistically significant differences in postoperative 1d of white blood cell count and fracture healing time be-tween the two groups(P＞0.05).No complications such as incision infection or internal fixation failure occurred in either group after surgery.At the last follow-up,there was no statistically significant difference in Harris scores be-tween the two groups(P＞0.05).Conclusions In the treatment of irreducible elderly intertrochanteric femoral frac-tures with InterTan intramedullary nail fixation,performing small incision assisted prying reduction immediately after the first failure of closed manual reduction can effectively shorten the anesthesia time and operation time,reduce an-esthetic dosage,inhibit inflammatory response,decrease perioperative risks,and improve treatment safety.
刘志伟;陈飞鹏;赵宝平;董文涛;刘钢
兴义市人民医院创伤骨科,贵州 兴义 562400兴义市人民医院创伤骨科,贵州 兴义 562400兴义市人民医院创伤骨科,贵州 兴义 562400贵州医科大学附属医院急诊科,贵州 贵阳 550001贵州医科大学附属医院急诊科,贵州 贵阳 550001
医药卫生
难复性股骨转子间骨折InterTan髓内钉固定闭合复位撬拨复位
irreducible intertrochanteric femoral fractureInterTan intramedullary nail fixationclosed reductionpry-ing reduction
《临床骨科杂志》 2026 (2)
231-234,4
贵州省黔西南州科技局医学科研联合项目(编号:州科合医学2025-76)
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