股骨近端可膨胀髓内钉治疗股骨粗隆间骨折及相关并发症的防治  

Treatment of intertrochanteric fracture with expandable proximal femoral nail and prevention and cure of some related complications

作　　者：陆晴友[1] 彭庄[1] 祝建光[1] 李立钧[1] 

机构地区：[1]同济大学附属东方医院骨科,上海200120

出　　处：《中国矫形外科杂志》2009年第4期248-251,共4页Orthopedic Journal of China

摘　　要：[目的]探讨股骨近端膨胀髓内钉治疗股骨粗隆间骨折及其并发症的防治。[方法]58例股骨粗隆间骨折,其中男28例,女30例。年龄42～88岁,平均73.2岁,Evans分型:Ⅰ型5例,Ⅱ型7例,Ⅲ型28例,Ⅳ型13例,Ⅴ型5例,均采用可膨胀股骨近端髓内钉行股骨粗隆间骨折内固定。[结果]58例中获得随访38例,随访时间12～36个月,平均随访时间18.5个月,骨折于8～10周均获临床愈合,髋关节Harris评分平均91.8分。并发症情况:术中出现大粗隆开口进针点附近继发性骨折1例、股骨头栓钉未入锁孔1例、栓钉头部破损1例,术后髋内翻畸形1例、股骨中上段骨折1例、股骨头栓钉退出1例。[结论]可膨胀股骨近端髓内钉具有微创、操作简便、固定可靠、取出方便等优点,但在初期使用时一定要熟悉其构造及固定原理并严格按照其操作规程进行,减少、避免因操作不当所致的手术失败。[ Objective] To explore the treatment of intertroehanteric fracture with expandable proximal femoral nail and prevention and cure of some related complications. [ Method] Fifty-eight cases of closed intertroehanterie fracture,including 28 male cases and 30 female,average 73.2 years old （ range from 42 to 88） accepted treatment. The type of fracture according to Evans classification：5 cases were type Ⅰ ,7 were type Ⅱ ,28 were type Ⅲ ,13 were type Ⅳ ,and 5 were type Ⅴ. All cases were treated with expandable proximal femoral intramedullary hall after close reduction. [ Result] Thirty-eight cases were followed up, from 12 to 36 months, average 18.5 months,all of the cases got clinical healing after 8 - 10 weeks postoperatively. Hip Harris score average was 91.8. Some complications occurred in 6 cases：l case bad secondary fracture nearby the greater trochanter needling insertion point, 1 case femoral head peg was outside of the lock hole, and 1 case femoral head peg tip was broken during operation. And after operation, 1 case had coxa vara deformation, 1 case had femoral middle and superior segment fracture, and 1 case femoral head peg was exited. [ Conclusion ] Expandable proximal femoral intramedullary nail has some advantages as ： minimal invasive, manipulation convenient, fixation reliability, remove easily, but surgeons must be familiar with the construction and fixation principle of the nail in the primary stage, and perform the operating instruction strictly, to reduce or avoid the complications occurrence because of mis - manipulation.

关 键 词：股骨近端可膨胀髓内钉 股骨粗隆间骨折 并发症 

分 类 号：R687.3[医药卫生—骨科学]