传统切开复位与顺势反向牵引复位微创固定治疗股骨远端骨折的临床比较

目的探讨顺势反向牵引复位微创固定与传统切开复位固定治疗股骨髁上骨折的临床效果比较。 方法采用回顾性病例对照研究分析2016年9月至2017年12月，安徽省立医院收治的32例股骨髁上骨折患者的临床资料，根据治疗方式的不同将其分为两组，传统切开复位固定术组（传统组）15例；顺势反向牵引复位经皮固定组（微创组）17例。均采用股骨外侧钢板固定，比较两组患者术中出血量、手术时间、复位时间、透视次数、术后一周膝关节HSS评分及并发症发生率。 结果全部患者均获得随访，微创组术中出血量为（170±27）ml，手术时间为（76±7）min，复位时间为（14.4±2.7）min，透视次数为（7.9±1.6）次，术后并发症发生率为6%，均优于传统组[（377±92）ml、（84±11）min、（25.2±4.6）min、（13.2±3.4）次]，差异均有统计学意义（均P<0.05）；两组术后1 w HSS评分差异无统计学意义。 结论顺势反向牵引复位经皮钢板固定治疗股骨远端骨折较传统切开复位内固定手术时间短、术中出血少、复位时间短、透视次数少，术后并发症发生率低，并可达到较好的临床效果。

Clinical comparison between traditional open reduction and Zhang's traction device for minimally invasive treatment of distal femoral fractures

ObjectiveTo compare the clinical effects of Zhang's traction device and minimally invasive fixation combine with conventional open reduction and fixation for the treatment of distal femoral fractures. MethodsA retrospective case-control study was conducted to analyze the clinical data of 32 patients with distal femoral fractures admitted to Anhui Provincial Hospital of Anhui Medical University from September 2016 to December 2017. They were divided into two groups according to different treatment methods. In the traditional open reduction and fixation group (traditional group), 15 cases were treated with Zhang's traction device and percutaneous fixation group (minimally invasive group). The femoral lateral plate fixation was used to compare the intraoperative blood loss, operation time, reduction time, number of fluoroscopy, knee joint HSS score and complication rate. ResultsThere was no significant difference in the general data between the two groups. The intraoperative blood loss was (170±7) ml, the operation time was (76±7) min, the reset time was (14.4±2.7) min, and the number of fluoroscopy was (7.9±1.6) times, the postoperative complication rate was 6%, which was superior to the traditional group. The difference was statistically significant (all P<0.05). There was no significant difference in knee HSS between the two groups 1 week after surgery. ConclusionsReduction with Zhang's traction device and percutaneous plate fixation for the treatment of distal femoral fractures has shorter reduction time, less intraoperative bleeding, shorter reset time, less fluoroscopy, and lower postoperative complications than conventional open reduction and internal fixation, this method can achieve good clinical results.