Objective: To compare the effectiveness of lower extremity axial distractor (LEAD) and traction table assisted closed reduction and intramedullary nail fixation in treatment of femoral subtrochanteric fracture.
Methods: The clinical data of 117 patients with subtrochanteric fracture of femur treated by closed reduction and intramedullary nail fixation between May 2012 and May 2022 who met the selection criteria were retrospectively analyzed. According to the auxiliary reduction tools used during operation, the patients were divided into LEAD group (62 cases with LEAD reduction) and traction table group (55 cases with traction table reduction). There was no significant difference in baseline data, such as gender, age, injured side, cause of injury, fracture Seinsheimer classification, time from injury to operation, and preoperative visual analogue scale (VAS) score, between the two groups ( P>0.05). Total incision length, operation time, intraoperative blood loss, fluoroscopy frequency, closed reduction rate, fracture reduction quality, fracture healing time, weight-bearing activity time, and incidence of complications, as well as hip flexion and extension range of motion (ROM), Harris score, and VAS score at 1 month and 6 months after operation and last follow-up were recorded and compared between the two groups.
Results: There were 14 cases in the LEAD group from closed reduction to limited open reduction, and 43 cases in the traction table group. The incisions in the LEAD group healed by first intention, and no complication such as nerve and vascular injury occurred during operation. In the traction table group, 3 cases had perineal crush injury, which recovered spontaneously in 1 week. The total incision length, operation time, intraoperative blood loss, fluoroscopy frequency, and closed reduction rate in the LEAD group were significantly better than those in the traction table group ( P<0.05). There was no significant difference in the quality of fracture reduction between the two groups ( P>0.05). Patients in both groups were followed up 12-44 months, with an average of 15.8 months. In the LEAD group, 1 patient had delayed fracture union at 6 months after operation, 1 patient had nonunion at 3 years after operation, and 1 patient had incision sinus pus flow at 10 months after operation. In the traction table group, there was 1 patient with fracture nonunion at 15 months after operation. X-ray films of the other patients in the two groups showed that the internal fixator was fixed firmly without loosening and the fractures healed. There was no significant difference in fracture healing time, weight bearing activity time, incidence of complications, and postoperative hip flexion and extension ROM, Harris score, and VAS score at different time points between the two groups ( P>0.05).
Conclusion: For femoral subtrochanteric fracture treated by close reduction and intramedullary nail fixation, compared with traction table, LEAD assisted fracture reduction can significantly shorten the operation time, reduce intraoperative blood loss and fluoroscopy frequency, reduce incision length, effectively improve the success rate of closed reduction, and avoid complications related to traction table reduction. It provides a new method for good reduction of femoral subtrochanteric fracture.
目的: 比较下肢轴向牵引器与牵引床辅助股骨转子下骨折术中闭合复位髓内钉固定的疗效。.
方法: 回顾分析2012年5月—2022年5月收治且符合选择标准的117例股骨转子下骨折患者临床资料，采用闭合复位髓内钉固定治疗。根据术中使用的辅助复位工具将患者分为牵引器组（62例，采用下肢轴向牵引器复位）与牵引床组（55例，采用牵引床复位）。两组患者性别、年龄、受伤侧别、致伤原因、骨折Seinsheimer分型、受伤至手术时间及术前疼痛视觉模拟评分（VAS）等基线资料比较差异均无统计学意义（ P>0.05）。记录并比较两组患者切口总长度、手术时间、术中出血量、透视次数、闭合复位率、骨折复位质量、骨折愈合时间、负重活动时间及并发症发生率，以及术后1、6个月和末次随访时髋关节屈-伸活动度（range of motion，ROM）、Harris评分、VAS评分。.
结果: 牵引器组和牵引床组分别有14例和43例由闭合复位转向有限切开复位。牵引器组患者切口均Ⅰ期愈合，术中无神经、血管损伤等并发症发生；牵引床组术中3例出现会阴部挤压伤，1周左右自行恢复。牵引器组切口总长度、手术时间、术中出血量、透视次数、闭合复位率均显著优于牵引床组（ P<0.05）；两组术后骨折复位质量差异无统计学意义（ P>0.05）。两组患者均获随访，随访时间12～44个月，平均15.8个月。牵引器组有1例患者术后6个月骨折延迟愈合，1例术后3年骨折不愈合，1例术后10个月出现切口窦道流脓；牵引床组有1例患者术后15个月骨折不愈合。两组其余患者定期复查X线片示内固定物固定牢靠、无松动，骨折均愈合。两组骨折愈合时间、负重活动时间、并发症发生率及术后各时间点髋关节屈-伸ROM、Harris评分、VAS评分比较差异均无统计学意义（ P>0.05）。.
结论: 与牵引床相比，股骨转子下骨折闭合复位髓内钉固定术中采用下肢轴向牵引器辅助复位可显著缩短手术时间，减少术中出血量及透视次数，并能减小切口长度，有效提高闭合复位成功率，避免牵引床复位相关并发症，为股骨转子下骨折良好复位提供了一种有效方案。.
Keywords: Subtrochanteric fracture; intramedullary nail fixation; lower extremity axial distractor; traction table.