经皮穿针骨水泥球结状外固定治疗股骨转子部骨折的实验研究和临床应用  

PercutaneousSteinmann'sPinwithBoneCementBalfortheExternalFixationTreatmentofTrochantericFractureoftheFemur

作　　者：马志新[1,2] 李晓东[1,2] 黄涛[1,2] 肖宇龙[1,2] 刘晓民[1,2] 李恩超[1,2] 李惠明[1,2] 苏伯固 

机构地区：[1]内蒙古医学院第二附属医院骨科 [2]第一附属医院骨科

出　　处：《中华骨科杂志》1996年第4期221-224,共4页Chinese Journal of Orthopaedics

摘　　要：针对股骨转子部骨折的特点，利用骨水泥对钢针的坚强锚固作用，作者设计了经皮穿针骨水泥球结状外固定技术。经生物力学测试，用该技术固定的骨折标本，平均最大抗压能力达到１８７±３２．４ｋｇ（χ±ｓ），与鹅颈钉相近（Ｐ值＞０．２５）。自１９９１年１月以来，采用该技术共治疗股骨转子部骨折５０例（平均年龄６４．１岁）。有４８例经过平均２０．５个月随访，优良４４例（９１．７％），尚好４例（８．３％）。作者认为该技术通过对钢针进行“两点锚固”和建立稳定的三角形整体结构，可有效地防止髋内翻并实现可靠固定，作为一种创伤轻微的有限手术，有其一定的应用价值。TheauthorsdesignedatechniqueofpercutaneousSteinmann'spinwithbonecementbal(PCSPBCB)forexternalfixationoftrochantericfractureofthefemur.EvansIatypespecimensoffemoraltrochantericfractureweremadein18adultspecimensofupperfemoralsegmentsandweredi-videdinto3groups.GroupAwerefixedwiththeSteinmannpinplusbonecementbaltechnique;groupwithSteinmannpinonly,andgroupCwithMclaughtinnails.Mechanicaltestsrevealedthat,themaxi-mumloadofgroupAandCreached187±32.4kg(χ±s)and179.5±30.4kg(χ±s)respectively,withoutsignificantdifference(P>0.25).GroupBreachedonly111.7±7.3kg(χ±s)andwasmuchlessthanthatofgroupAandC.SinceJanuary1991,50casesoffemoraltrochantericfractureweretreatedwiththetechniqueofPCSPBCB.Theageofthepatientswasinaverage64.1years.Ac-cordingtoEvans'classification,14casesbelongedtothestabletypeand36totheunstabletype.Theprocedurewasdoneunderfluoroscopyandlocalanaesthesia.Steinmannpinsof3.5～4.0mmindiame-terwereusedforpercutaneousfixation.Thefirstandthesecondpinswereinsertedinaparalelmannerthroughthecalcarfemoraltothefemoralheadoveritsupperandloweredges.Thethirdpinwasinsert-edovertheuppersegmentofthefemurshaftaftercrossingtheexposedendsofthefirstandthesecondpins.Thetwointersectionssoformedbetweenthethreepinswerethenfixedwithbonecementintheformofabal.Aftertheoperation,thepatientswereencouragedtodoexerciseofthelegearly,andbearingweight.48patientswerefolowedupfor20.5monthsinaverageandthefractureswerehealedupinalwithin3months.Nocasedevelopedcoxavara.44(91.7%)caseshadexcelentorgoodresultsand4cases(8.3%)hadsatisfactoryresults.

关 键 词：股骨 转子部 骨折 骨水泥 外固定 

分 类 号：R683.42[医药卫生—骨科学]