The Application Of Homeopathic Bidirectional-traction Device In The Treatment Of Intertrochanteric Fractures Of The Femur In Young And Adult Patients

Objective: Intertrochanteric fracture is a very common type of fracture in clinic,currently fixation of the proximal femur by intramedullary nail after traction bed is a recognized surgical method.But the traction bed has many complications such as small traction force and perineal crush injury.In order to solve the above problems,Doctor Zhang Yingze invented homeopathic bidirectional-traction device to treat lower limb fractures.The aim of this study was to compare the clinical effects of homeopathic bidirectional-traction device and traction table in the treatment of intertrochanteric fractures fixed with intramedullary nail in the young and middle aged patients.Methods: The prospective case-control study was conducted in the Third Hospital traumatic emergency center of Hebei Medical University Hospital,patients diagnosed with intertrochanteric fractures between July 2016 and June 2017 were included,patients were randomized into bidirectional-traction group and traction table group using a random number table method.All patients were randomly divided into bidirectional-traction group and traction table group using random number table method.Bidirectional-traction group referred to homeopathic bidirectional-traction device and the traction table group used the traction table for reduction.All patients were immobilized with proximal femoral nail.The operation time,reset time,fluoroscopy time,blood loss and closure reduction rate of two groups were compared.Follow-up were conducted at 1 month,3 mouth and 6 month postoperatively.Radiographs of the affected side were taken and the fracture healing was evaluated.At the 1 month postoperatively,a calib calibrator was used to take a lateral radiograph of the knee joint of the affected limb,and the degree of tibial rotation of the affected femur was measured.At the final follow-up,Harris score was used to assess the functional recovery of the affected hip.Results: During the study period,78 patients with intertrochanteric fracture of the femur were treated,38 patients in the bidirectional-traction group and 40 patients in the traction table group.There were 62 males and 16 females,aged 21-59 years.According to AO classification,there were 21 cases of 31A1 fractures,28 cases of 31A2 fractures,and 29 cases of 31A2 fractures.The double reverse traction group,included 30 males and 8 females,aged 21-59 years,with a mean age of 46.1±11.5 years;22 cases on the left and 16 on the right;11 cases of 31-A1 type,14 cases of 32-A2 type,and 13 cases of 31-A3 type.There were 20 cases combined with other injuries.Traction table group included 32 males and 8 females,aged 23-59 years,with a mean age of 45.9±12.3 years;18 cases on the left side,22 cases on the right side;10 cases of 31-A1,There were 14 cases of 31-A2 and 16 cases of 31-A3 and 20 cases combined with other injuries.No statistical differences were found in age,gender,fracture classification,follow-up time,and combined injury between the two groups.With the application of homeopathic bidirectional-traction device,all fractures were reduced closely in the bidirectional-traction group.While 8 fractures in the traction table group were reduced via a small anterior approach.In the bidirectional-traction group,the operative time,reduction time,and fluoroscopy time were(86±23)min,(7.8±1.7)min,and(13±3.0)s,respectively,which were all significantly lesser than the corresponding data in the traction table group(104±25 min,14.4±3.3 min,21±3.6 s)(all P<0.05).Postoperative lower extremity shortening in bidirectional-traction group(3.5?1.5 mm)was significantly lower than the bidirectional-traction group(8.3?3.9 mm)(P<0.05).The rotation of the affected femur to the tibia was(3.1?1.3)° as measured on the radiographs taken one month postoperatively,which is significantly less than the rotation of(9.9?3.5)° measured in the traction table group(P<0.05).At the final follow-up,patients in bidirectional-traction group all achieved bone union while 3 cases in the traction table group still had problem in fracture union.The Harris score at the final follow-up was(90.9±5.6)in bidirectional-traction group,which was better than the traction table group(88.1±5.2,P<0.05),the bidirectional-traction group had no traction related complications,and the blood loss and other complications had no significant difference between two groups.Conclusion: Compared to traction table,the homeopathic bidirectional-traction device can be used to reduce the intertrochanteric fracture of the young and middle aged patients with a high rate of closed reduction,shorter operative time,less radiological exposure and enhance the surgical effectiveness.