原位髋部透视法在股骨颈内固定术中的临床应用

目的探讨原位髋部透视法在股骨颈内固定术中的应用疗效。方法回顾性分析2015年8月至2018年8月收治的69例股骨颈骨折患者。根据术中透视方法不同分为2组:原位组35例,采用双下肢对称牵持续引下,股骨颈骨折复位后原位髋部C型臂X线机透视;对照组34例,采用健侧蛙式位、患髋牵引复位下C型臂X线机透视。比较两组患者的术中透视次数、导针重置次数、术中伤口出血量及全程手术时间。结果原位组与对照组股骨颈骨折患者性别、年龄、骨折分型、致伤原因、受伤至手术时间等术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。原位组全程术中透视次数(7.2±0.5)次]、导针重置次数(2.1±0.3)次]、术中伤口出血量(96.8±18.6)mL]、全程手术时间(1.2±0.2)h]均明显少于对照组(16.1±1.2)次、(4.7±0.8)次、(198.1±13.2)mL、(1.6±0.3)h],差异均有统计学意义(P<0.05)。结论原位髋部透视由于双下肢维持对称牵引状态,勿须变动髋关节体位,因而维护骨折复位后的稳定。C型臂X线机透视操控简捷,影像清晰可辨。因此,原位髋部透视法具有术中透视和导针重置次数少,进而大大减少了术中伤口出血量、缩减了无效的手术时间和麻醉时间等优点。

C-arm hip fluoroscopy at primary position in the internal fixation of femoral neck fracture

Objective To evaluate the hip C-arm fluoroscopy at primary position in internal fixation of femoral neck fracture.Methods A retrospective study was conducted of the 69 patients with femoral neck fracture who had been treated from August 2015 to August 2018.They were divided into a primary position group(n=35)subjected to C-arm hip fluoroscopy at primary position under symmetry traction of bilateral lower limbs for reduction of femoral neck fracture and a control group(n=34)subjected to C-arm hip fluoroscopy at frog’s position on the healthy side for traction and reduction of the injured hip.The 2 groups were compared in terms of fluoroscopy frequency,times of resetting guide pin,intraoperative blood loss and total operation time.Results The 2 groups were comparable due to insignificant significances between them in the preoperative general data like gender,age,fracture type,injury cause,or interval from injury to operation(P>0.05).Compared with the control group,the primary position group showed less intraoperative fluoroscopy(7.2 times±0.5 times versus 16.1 times±1.2 times),fewer times of resetting guide pin(2.1 times±0.31 times versus 4.7 times±0.8 times),less intraoperative blood loss(96.8 mL±18.6 mL versus 198.1 mL±13.2 mL),and shorter total operation time(1.2 h±0.2 h versus 1.6 h±0.3 h).All the differences were statistically significant(P<0.05).Conclusions C-arm hip fluoroscopy at primary position may protect the stability after fracture reduction because bilateral lower limbs are under symmetrical traction and the hip position needs no alteration.Operation of C-arm fluoroscopy is easy and convenient and produces clear images.Therefore,this new mode of fluoroscopy has advantages of less intraoperative fluoroscopy and guide pin resetting,leading to significantly reduced intraoperative blood loss,ineffective operation time and anesthesia time.