侧卧位牵引架闭合复位髓内钉固定治疗股骨干骨折

《中国组织工程研究》 Chinese Journal of Tissue Engineering Research

1847

·研究原著·

袁野，男，1984年生，2008年遵义医学院(遵义医科大学)毕业，主治医师，主要从事四肢骨折的微创治疗及骨盆骨折的微创及手术治疗。

通讯作者：黄文良，硕士，副主任医师，遵义医科大学第三附属医院创伤骨科，贵州省遵义市 563000

文献标识码:A

投稿日期：2019-08-10 送审日期：2019-08-14 采用日期：2019-10-09 在线日期：2019-11-19

Yuan Ye, Attending physician, Department of Orthopedics and Traumatology, the Third Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China

Corresponding author: Huang Wenliang, Master, Associate chief physician, Department of Orthopedics and Traumatology, the Third Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China

侧卧位牵引架闭合复位髓内钉固定治疗股骨干骨折

袁 野，黄文良，徐 林，阮世强，王世强(遵义医科大学第三附属医院创伤骨科，贵州省遵义市 563000) DOI:10.3969/j.issn.2095-4344.2519 ORCID: 0000-0002-4621-2653(袁野)

文章快速阅读：

文题释义：

闭合复位髓内钉固定：因闭合复位髓内钉术手术创伤小，能间接复位保护骨折端血运，术后伤口并发症较少，生物力学性能优越，已成为长骨干骨折的首选方法。

侧卧位与仰卧位牵引架牵引：术中通过充分对抗肌肉对抗力后，仰卧位对骨折端前后移位不好控制或纠正；侧卧位更方便纠正断端移位，且减少髋部软组织对手术操作的干扰。 摘要

背景：目前临床上对于股骨干骨折髓内钉治疗的闭合复位方式研究相对较少。 目的：探讨侧卧位应用牵引架闭合复位髓内钉固定治疗股骨干骨折的效果。

方法：遵义医科大学第三附属医院创伤骨科2015年1月至2018年10月通过髓内钉固定治疗股骨干骨折54例，随机分为3组，其中仰卧位牵引架组17例，侧卧位人工牵引组17例，侧卧位牵引架组20例。所有患者对治疗方案均知情同意，且得到医院伦理委员会批准。比较3组患者的闭合复位成功率、手术时间、术中出血量、骨折愈合时间及术后 6个月膝关节美国特种外科医院评分。

结果与结论：①3组患者获得6-15个月随访；②骨折闭合复位成功率：侧卧位牵引架组100%，侧卧位人工牵引组82%，仰卧位牵引架组59%，仰卧位牵引架组同侧卧位人工牵引组差异无显著性意义(P > 0.05)，侧卧位牵引架组显著高于仰卧位牵引架组(P =0.002)，侧卧位牵引架组同侧卧位人工牵引组差异无显著性意义(P > 0.05)；③手术时间：仰卧位牵引架组同侧卧位人工牵引组比较差异无显著性意义(P > 0.05)，侧卧位牵引架组的手术时间显著短于仰卧位牵引架组及侧卧位人工牵引组(P < 0.05)；④术中出血量：仰卧位牵引架组的术中失血量显著高于侧卧位人工牵引组(P =0.02)及侧卧位牵引架组(P =0.001)，侧卧位人工牵引组同侧卧位牵引架组差异无显著性意义(P > 0.05)；⑤骨折愈合时间：仰卧位牵引架组骨折愈合时间显著长于侧卧位人工牵引组(P =0.030)及侧卧位牵引架组(P < 0.001)，侧卧位人工牵引组同侧卧位牵引架组差异无显著性意义(P > 0.05)；⑥3组患者术后6个月膝关节美国特种外科医院评分差异无显著性意义(P > 0.05)；⑦结果表明，应用侧卧位牵引架闭合复位髓内钉固定治疗股骨干骨折具有复位成功率高、手术时间较短、术中出血更少、骨折愈合快的优点，值得临床推广应用。 关键词：

侧卧位；牵引架；闭合复位；股骨干骨折；髓内钉 中图分类号：R459.9；R318；R687

Treatment of femoral shaft fracture with lateral traction frame closed reduction and intramedullary nail fixation

Yuan Ye, Huang Wenliang, Xu Lin, Ruan Shiqiang, Wang Shiqiang (Department of Orthopedics and

Traumatology, the Third Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China)

袁野，黄文良，徐林，阮世强，王世强. 侧卧位牵引架闭合复位髓内钉固定治疗股骨干骨折[J]. 中国组织工程研究，2020，24(12):1847-1852. DOI:10.3969/j.issn.2095-4344.2519

1848

Abstract

BACKGROUND: At present, there are relatively few studies on the closed reduction of intramedullary nail treatment for femoral shaft fractures.

OBJECTIVE: To investigate the effect of closed reduction and intramedullary nailing in the treatment of femoral shaft fractures in the lateral position.

METHODS: From January 2015 to October 2018, 54 patients with femoral shaft fractures were treated with intramedullary nailing at

Department of Orthopedics and Traumatology, the Third Affiliated Hospital of Zunyi Medical University. The patients were randomly assigned to three groups, including 17 cases in the supine mechanical traction group, 17 cases in the lateral artificial traction group, and 20 cases in the lateral mechanical traction group. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee.

Closed reduction success rate, operation time, intraoperative blood loss, fracture healing time, and hospital for special surgery knee score at 6 months after surgery were compared in the three groups.

RESULTS AND CONCLUSION: (1) All patients were followed up for 6 to 15 months. (2) The success rate of fracture closure was 100% in the lateral mechanical traction group, 82% in the lateral artificial traction group, and 59% in the supine mechanical traction group. There was no significant difference between supine mechanical traction group and lateral artificial traction group (P > 0.05). The success rate was

significantly higher in the lateral mechanical traction group than in the supine mechanical traction group (P =0.002). There was no significant difference between the lateral mechanical traction group and the lateral artificial traction group (P > 0.05). (3) No significant difference was found in operation time between the supine mechanical traction group and the lateral artificial traction group (P > 0.05). The operation time was significantly shorter in the lateral mechanical traction group than in the supine mechanical traction group and lateral artificial traction group (P < 0.05). (4) Intraoperative blood loss was significantly more in the supine mechanical traction group than in the lateral artificial

traction group (P =0.02) and lateral mechanical traction group (P =0.001). No significant difference was determined in intraoperative blood loss between the lateral artificial traction group and lateral mechanical traction group (P > 0.05). (5) Fracture healing time was significantly longer in the supine mechanical traction group than in the lateral artificial traction group (P =0.030) and lateral mechanical traction group (P < 0.001). There was no significant difference in fracture healing time between the lateral artificial traction group and the lateral mechanical traction group (P > 0.05). (6) No significant difference in hospital for special surgery knee score at 6 months after surgery was detected among the three groups (P > 0.05). (7) These results suggested that application of lateral recumbent traction frame closure and intramedullary nailing for the treatment of femoral shaft fractures has the advantages of high success rate, short operation time, less intraoperative blood loss and short fracture healing time. It is worthy of clinical application.

Key words: lateral position; traction; closed reduction; femoral shaft fracture; intramedullary nail

0 引言 Introduction

股骨干骨折是骨科最常见的骨折之一，成人常由高坠伤、车祸伤等高能量损伤导致[1]，髓内钉治疗股骨干骨折已被广泛接受，随着技术的进步与对骨折生物学的进一步认识，闭合复位联合髓内钉固定已成为股骨干骨折的首选方法

[2-5]

，具有创伤及失血量小、中轴固定、应力分散等优点，术后骨折愈合率高[6]、感染率低、术后可早期活动等[7]，特别对于严重粉碎性股骨干骨折具有钢板所没有的优 势[8]

。目前治疗股骨干骨折应用最广泛的体位主要有2种，即仰卧位牵引架牵引及侧卧位人工牵引[9]，遵义医科大学第三附属医院自2015年1月至2018年10月分别应用仰卧位牵引架牵引、侧卧位人工牵引、侧卧位牵引架牵引3种方法联合闭合复位交锁髓内钉固定治疗股骨干骨折，54例患者均获得随访，比较3种牵引方法的疗效，报道如下。

1 对象和方法 Subjects and methods

1.1 设计 前瞻性随机对照试验。

1.2 时间及地点 病例资料来自于2015年1月至2018年10月遵义市第一人民医院(即遵义医科大学第三附属医院)创伤骨科。

1.3 材料 金属带锁髓内钉的材料学特征见表1。 1.4 对象

纳入标准：①年龄≥18岁；②新鲜单侧股骨干骨折(股骨小转子以下至股骨髁上8 cm 的骨折)；③病历资料完整者。

排除标准：①病理性股骨干骨折；②髓腔明显狭窄或存在畸形的股骨干骨折；③股骨干骨折合并神经、血管损

伤；④Gustilo Ⅱ度以上的严重开放性股骨干骨折；⑤合并脊柱、骨盆损伤或其他损伤不能施行侧卧体位者；⑥患有其他影响患肢功能疾病。

纳入54例股骨干骨折患者中男31例，女23例；年龄18-64岁，平均42.83岁；AO 分型：A 型27例，B 型22例，C 型5例；损伤原因：车祸28例，高处坠落致伤18例，自行摔伤8例。按随机数字表法分组，其中仰卧位牵引架组17例，侧卧位人工牵引组17例，侧卧位牵引架组20例，所有患者对治疗方案均知情同意，且得到医院伦理委员会批准。手术均为第一、四、五作者共同参与(主任、副主任、主治

表1 植入物的材料学特征 Table 1 Material characteristics of the implant 指标 金属带锁髓内钉

生产厂家 厦门大博颖精医疗器械有限公司 型号 A-UFN-02 批准号

B150105315

性能结构

直径9.0-11.0 mm ，直径每增加1.0 mm 为1个规格，共3种规格，均为顺行髓内钉

材质

采用复合ISO5832-3标准规定的Ti6A14V 钛合金或符合GB4234标准规定的00Cr18Ni14Mo3不锈钢材料制造，钛合金产品表面经阳极氧化处理，无菌和非无菌包装 适应证 适用于股骨干骨折内固定

生物相容性

钛合金髓内钉物化性质上非常稳定，强度高、质量较轻，无毒，不会被人体吸收，不与体液和药物发生反应，不会离子化，也不会与人体骨骼发生反应，适用于任何灭菌方法 产品标注的不

良反应

①金属过敏反应或异物排斥反应；②压迫导致局部骨坏死，应力遮挡导致局部骨质疏松，均易引发内固定取出后再骨折；③过早不恰当负重导致的金属疲劳断裂；④由于植入物存在产生疼痛、不适或感觉异常；⑤植入物松动、弯曲、断裂、导致术后骨不连或骨延迟愈合；⑥感染