联合拉力交锁髓内系统治疗股骨转子间骨质疏松性骨折  

Locking intramedullary nail combined with compression screw in treatment of osteoporotic intertrochanteric fractures

作　　者：施慧鹏[1] 孙辉[1] 李晓林[1] 王俏杰[1] 罗从风[1] 张长青[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,200233

出　　处：《上海医学》2011年第3期171-175,F0002,共6页Shanghai Medical Journal

摘　　要：目的前瞻性研究联合拉力交锁髓内钉系统(Inter-TAN)治疗股骨转子间骨质疏松性骨折的临床效果。方法设立入组及排除标准后,2008年3月-2010年3月共有24例闭合性骨质疏松性转子间骨折患者入组,男15例,女9例,年龄60～81岁,平均年龄为(68±6)岁。股骨转子间骨折按国际内固定研究学会(AO/ASIF)分型(AO31-):A1型5例,A2型17例,A3型2例。按Evans分型:Ⅰ型3度5例,Ⅰ型4度17例,Ⅱ型2例。对所有患者的Singh指数进行分度:Ⅲ度6例,Ⅱ度14例,Ⅰ度4例。均进行手术治疗,用Inter-TAN内固定。随访内容包括骨折愈合情况、顶尖距(TAD)值变化情况、术后并发症、髋关节Harris评分。结果本组病例均获得随访,平均随访时间为(18±3)个月,骨折均牢固愈合,X线片上骨折愈合时间为5～17周,平均为(8.0±1.4)周。末次随访时,患侧髋关节Harris评分平均为(76.0±7.3)分,与健侧髋关节的(80.0±8.5)分的差异无统计学意义(P>0.05)。功能评价优12例(50.0%),良6例(25.0%),中3例(12.5%),差3例(12.5%)。结论 Inter-TAN固定股骨转子间骨质疏松性骨折的稳定性好,既有滑动加压效果,又有抗旋转作用,其双钉模式还避免产生"Z-效应",是治疗股骨转子间骨质疏松性骨折安全、有效的方法 。Objective To prospectively determine the therapeutic effect of antegrade intertrochanteric nail（Inter-TAN）for the treatment of osteoporotic intertrochanteric fractures.Methods From March 2008 to March 2010,24 patients with closed intertrochanteric osteoporotic fractures hospitalized in our department were enrolled,including 15 males and 9 females with an averaged age of（68±6）（ranging from 60 to 81）.All the fractures were classified by the AO/The Association for the Study of Internal Fixation（ASIF）classification（AO 31-）as Type A1 in 5 cases,Type A2 in 17 and Type A3 in 2 cases.When classified by Evans classification,5 cases belonged to Type 13,17 cases to Type I4 and 2 cases to Type Ⅱ.The Singh index of the patients ranked III degree in 6 cases,Ⅱ in 14 and Ⅰ in 4 cases.All fractures were internally fixed by Inter-TAN.During the follow-up,the fracture healing,tip-apex distance（TAD）changes,complications,Harris hip score were observed and assessed.Results A mean follow-up of（18±3）months was done in patients in this series.All the fractures healed with a mean healing time of（8.0±1.4）weeks（ranging from 5 to 17 weeks）.At the final follow-up,the mean hip Harris score was 76.0±7.3,which had no significant difference with that of the healthy sides（80.0±8.5,P0.05）.The functional evaluation revealed that excellent outcomes were achieved in 12 cases（50.0%）,good in 6（25.0%）,fair in 3（12.5%）and poor in 3 cases（12.5%）.Conclusion In the treatment of osteoporotic intertrochanteric fractures,Inter-TAN provides good stability,interfragmental compression by gliding effect,antirotation and avoidance of Z-effect,and is a safe and effective treatment for osteoporotic intertrochanteric fractures.

关 键 词：骨质疏松性骨折 股骨 转子间骨折 髓内钉 骨折固定 

分 类 号：R687.3[医药卫生—骨科学]