股骨转子间骨折微创内固定术的临床分析  

Clinical aualysis of minimally invasive internal fixation for the treatment of intertrochanteric femoral fractures

作　　者：孔建中[1] 洪汝康[1] 王振文[1] 陈华[1] 王向阳[1] 彭茂修[1] 

机构地区：[1]浙江省温州医学院附属第二医院,温州325000

出　　处：《浙江创伤外科》2005年第1期4-6,共3页Zhejiang Journal of Traumatic Surgery

基　　金：温州市科技局科研基金资助项目(S2002A043)

摘　　要：目的回顾分析股骨转子间骨折微创内固定术以提高其临床疗效。方法回顾分析C形臂X线光机透视下闭合复位,经皮动力髋螺钉(DHS)内固定术治疗股骨转子间骨折109例,男68例,女41例;年龄42～92岁,平均67.5岁。结果切口长度平均5.1cm;出血量平均49.5ml;手术时间平均38分钟;骨折全部愈合,临床愈合时间58～82天,平均66.5天;2例改切开复位内固定术;2例切口形成血肿;2例术中股骨颈后壁磨穿;1例因过度内旋固定致髋关节外旋受限;其余108例髋关节功能均正常。3例套筒钢板与股骨纵轴不一致;2例股外侧肌医源性损伤。X线评价:5例粗隆上移0.8～1.5cm;109例中未见髋内翻、髋螺钉切割、拔出或穿透股骨头。结论经皮DHS内固定术,是目前治疗股骨转子间骨折新的理想的微创治疗技术。严格掌握手术适应症,正确的手术操作,适时进行康复锻炼是治疗成功的关键,但微创手术内固定器械尚有待改进。Objective To improve the clinical effects through retrospective study of minimally invasive internal fixation for the treatment of intertrochanteric femoral fractures?Methods To study retrospectively 109 cases of intertrochanteric femoral fractures that were treated with closed reduction minimally invasive incision and dynamic hip screw (DHS) fixation under fluoroscopy guidance?Of these patients,68 cases were male and 41cases were female?The patient age ranged from 42 to 92 years (mean 66.5 years)? Results The mean length of incision was 5.1cm; the mean blood loss was 49.5ml; The mean duration of operation was 38min; the mean duration of bone healing was 67.5d(range,58 to 82d)?Two cases with wound hematomas and no infections were found.,The function of coax was normal in 108 cases,except for 1 case with sligtly restricted external rotation. The posterior walls of collum femoris of 2 cases were wear out during operating; The longitudinal axis of sleeve plate of 3 cases were uncoincidence with femur; The musculus vastus lateralis of 2 case were iatrogenicly damaged.Image evaluation: 5 case tuberositas were moved upward 0.8～1.5cm,No coxa vara and screw cuting～outs or pulling～out or penetrating into articular space were found? Conclusions The percutaneous DHS fixation is a new effective technique of minimal invasion for the treatment of intertrochanteric femoral fractures,It is the key point for the best therapy that the operation should be stridly indicated and correctly managed, that timely rehabilitation should be carried out at the right moment. But the instrumentation for internal fixation needs to be improved. Femoral

关 键 词：股骨转子间骨折 治疗 内固定术 回顾分析 经皮 微创 X线 透视 

分 类 号：R683[医药卫生—骨科学] R681[医药卫生—外科学]