Abstract：Objective To explore the effect of lateral recumbent position non-traction bed in the treatment of femoral subtrochanteric fracture with intramedullary nail fixation. Methods The clinical data of 34 patients with femoral subtrochanteric fractures and who were admitted to the Department of Orthopedics of Wuhe County People's Hospital from November 2015 to July 2018 were retrospectively analyzed, 20 males and 14 females, with average age of 23-83 (61.7±12.7) years old. The cases were Seinsheimer type ⅡA (five cases), type ⅡB (four cases), type ⅡC (seven cases), type ⅢA (three cases), type ⅢB (five cases), type Ⅳ (six cases), and type Ⅴ (four cases). Under the fluoroscopy of the C-arm X-ray machine, the patients were treated with closed reduction and intramedullary nail fixation without traction bed in the lateral recumbent position. The time from injury to operation was 1-12 (7.0±1.9) days. The preoperative posture time, operation time, intraoperative blood loss, X-ray fluoroscopy times, fracture reduction quality, postoperative complications, and fracture healing time were recorded. The hip joint visual analogue scale (VAS) and Harris score at 1 and 6 months and at the last follow-up were recorded and compared. The joint function was evaluated by Harris hip score. Results The postural time of the patients was 5-11 (7.7±1.6) min. The operation time was 29-82 (60.3±10.9) min. The intraoperative blood loss was 45-350 (212.3±57.8) mL. The fluoroscopy time was 18-53 (33.8±7.3) min. When radiography was performed immediately after the operation, the fracture reduction quality evaluation results showed an anatomic reduction in 13 cases and acceptable reduction in 21 cases. All the incisions healed in one stage after the operation, and no infection, deep venous thrombosis, and failure of internal fixation were observed. All 34 patients were followed up for 12-48 (22.4±7.7) months. One patient with Seinsheimer type Ⅳ still had no bone union at 7 months after the operation. For this case, autogenous iliac bone graft was performed and healed 3 months after the second operation. The fracture healing time was 4-12 (5.8±1.7) months. VAS scores were (4.76±0.96), (1.91±0.79), and (0.97±0.63) points, whereas Harris scores were (74.35±5.83), (78.79±6.31), and (85.76±6.53) points, respectively, at 1 and 6 months after surgery and at the last follow-up. These scores all showed statistically significant differences (all Pvalues＜0.05). At the last follow-up, hip joint function assessment was excellent in 11 cases, good in 20 cases, but good in 2 cases, and poor in 1 cases, with an excellent and good rate of 91.2%. Conclusions The method of application of lateral recumbent position non-traction bed in the treatment of femoral subtrochanteric fracture with intramedullary nail fixation is simple, minimally invasive, and can achieve satisfactory results. It is suitable for application and promotion in primary hospitals.
武红军, 周玉宽, 黄道文, 张彪, 张坤, 王广洋, 高朝平, 蔡德超. 侧卧位无牵引床髓内钉固定在股骨粗隆下骨折治疗中的应用[J]. 中华解剖与临床杂志, 2020, 25(6): 678-682.
Wu Hongjun, Zhou Yukuan, Huang Daowen, Zhang Biao, Zhang Kun, Wang Guangyang, Gao Chaoping, Cai Dechao. Application of lateral recumbent position non-traction bed in the treatment of femoral subtrochanteric fracture with intramedullary nail fixation. Chinese Journal of Anatomy and Clinics, 2020, 25(6): 678-682.
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2020, Vol. 25 
