| Objective: This study aimed to compare the outcomes of femoral shaft fractures treated with the homeopathic bidirectional-traction reduction device and traction table.Methods: 153 patients with femoral shaft fractures from January 2014 to December 2016 were recruited into our study.Patients were randomly divided into experimental group and control group.Demographic data including age,sex,fracture type,and comorbidity were collected.All cases were treated with PFN(Proximal Femoral Nails).The homeopathic bidirectional-traction was applied in the experimental group,while the traction table was used in the control group.In the experimental group,all the patients were placed in a prone position,and routine disinfection was performed.First,the dual traction reductor homeopathic fast was installed.Steinmann pin along the rotation axis of the femoral condyle or lateral tibial tubercle were inserted,respectively.the traction bow was then connected;the traction frame should be straddled the ipsilateral leg,and the traction bow was connected.Second,a 3cm incision should be made on the anterior superior iliac spine,and both sides of the cortex were exposed after separation layer by layer.We used electric drill to drill through inner and outer cortical spine of anterior superior iliac spine,implanted horizontal screw,and fixed vertical connection device on it.Importantly,appropriate traction screw should be selected,the vertical connection device and the reset frame should be next connected as a whole.Third,the lower limb should be placed in the rotation position after the correct connection of all reduction devices.Under the monitoring of C arm fluoroscopy,femoral condyle bone was drawed using rotating handle,which was confronted with proximal vertical connection device of anterior superioriliac spine.In the process of direct reduction,there were many disadvantages:the traction strength is powerful;traction line was consistent with the axis of the femur;In addition,the double reverse traction can prevent femoral dislocation resulted from the muscular tension.we rotated axis along femoral supracondylar femoral or tibial tubercle,which converted to be reduction force and extrusion force to the further reduction of fractures with the help of the surrounding muscle and ligament.So,the majority of fractures,such as verlap displacement,angular displacement,lateral displacement,and rotational displacement,were reseted with the homeopathy double reverse traction.There may be a few cases with remaining lateral displacement and rotational displacement.We can inserted Steinmann pin through femur screw holes and assisted lateral displacement.Internal and external rotation bow can correct rotation deformity and fractures reduction.Finally,after satisfactory fracture reduction,fixation components should be maintained.Fracture were treated with the suitable anterograde reamed femoral intramedullary nail(Proximal femur,nail,PFN)or Femoral interlocking intramedullary nail(Interlocking Intramedullary Nails,IIN).In the control group all the patients were treated with traction bed,and the patient's limbs were placed on the traction bed,and the traction line was adjusted under the monitoring of C arm fluoroscopy machine.Once there existed proximal forward and backward shift fracture,The reduction of femoral shaft fractures were achieved through pressing down implantation rod via small incision,Hoffman pull hook,and periosteal stripping ion.After the restoration of satisfaction,the appropriate PFN or IIN were choosed to fix fracture.Operation time,reduction ime,intraoperative fluoroscopy,and intraoperative blood loss were documented,radiologic data and functional outcomes were also collected after follow-up respectively..Results: 69 patients were included in the experimental group,and 84 patients were included in the control group.There were no significant differences in terms of age,sex,fracture type,ISS score and associated injuries between in the two groups.In the experimental group,all patientsobtained closed reduction and internal fixation with the application of homeopathic bidirectional-traction.Data of the experimental group including operative time65.0(20.0)min,reduction time6.0(3.0)min,fluoroscopy times17.0(5.0)times,and bleeding volume130.0(60.0)ml(),data of the control group including operative time75.0(15.0)min,reduction time9.0(5.0)min,fluoroscopy times19.0(7.0)times,and bleeding volume200.0(118.0)ml,all were significantly less than that of control group(P<0.05).Two groups of fractures healed.1 months after surgery,the experimental group of patient femur tibia relative 3.1(0.5)degree rotation,significantly less than the control group in 12.6(3.4)degrees relative rotation(P<0.05).The HSS score of final follow-up of the experimental group was 88.1±4.4,which was better than that of control group(P<0.05).The incidence of traction table complications in the control group was significantly higher than that in the experimental group(P<0.05).Conclusions: In this study,closed reduction with double traction device was used to treat femoral shaft fractures,which can achieve good effectiveness.Compared with the traction bed,this method can restore the lower limb alignment,prevent the occurrence of femoral malrotation,shorten the operation time and fluoroscopy time,reduce X-ray exposure,and facilitate early postoperative functional exercise.The application of dual traction can obtain accurate reduction during the minimally invasive fixation of femoral shaft fracture,which provided a new clinical treatment.It will be widely used in all kinds of bone fractures.In addition,dual traction also effectively reduceed the complications associated with traction bed,which was regarded asa key technology breakthrough in minimally invasive treatment of long bone fracture.Double traction device is simple and convenient,which can effectively maintain the high quality of fracture reduction.The application of the homeopathic bidirectional-traction device can reduce the occurrence of the femoral shaft fracture,restore the lower limb alignment,recover the function of hip and knee joint,and effectively reduce the complications associated with traction table.It is predicted that the homeopathic bidirectional-traction devicehas the broad prospects in clinical application especially in some primary hospitals. |
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