内侧皮质正性支撑复位对老年股骨粗隆间骨折内固定效果的影响  

Fracture reduction with positive medial cortical support in geriatric unstable pertrochanteric fractures treated with cephalomeduallary nail

作　　者：张世民[1] 张英琪[1] 李清[1] 杜守超[1] 姚勐炜[1] 张立智[1] 郭震[1] 吴旭[1] 胡孙君[1] 

机构地区：[1]同济大学附属杨浦医院骨科,上海市腾越路450号200090

出　　处：《中国矫形外科杂志》2014年第14期1256-1261,共6页Orthopedic Journal of China

摘　　要：[目的]介绍股骨粗隆间骨折内侧皮质正性支撑复位（股骨干内侧皮质在外下方承托头颈骨块内侧皮质）的概念，并探讨其对内固定影像学与功能效果的影响。[方法]回顾性分析2010年7月～2013午6月采用头髓钉（PFNA-Ⅱ或gamma-3）治疗的不稳定型顺向股骨粗隆问骨折127例（AO／OTA31A2），男32例，女95例，平均年龄78．7岁。根据正位X线片上头颈骨块内侧皮质与股骨干内侧皮质的位置关系，分为3个等级，即内侧皮质正性支撑（89例）、中性支撑（26例）和负性支撑（12例）。比较三组患者的基线状况、术后颈干角、股骨颈长度变化、康复进程和功能恢复情况。[结果]三组患者在年龄、性别比、骨折前的基本日常生活能力（BADL）、步行活动能力、手术危险度分级、内科合并症数目、骨质疏松Singh指数、术中骨折复位质量以及拉力螺钉（螺旋刀片）的置放（TAD）等基线方面，均无明显统计学差别。术后3个月影像学随访，皮质正性支撑组的颈干角和股骨颈长度丢失最少（平均0．7°和2．4mm），而负性支撑组丢失最多（平均8．9°和6．7mm），有显著性统计学差异。正性支撑组能早期下地负重行走，康复进程较快，且髋股部疼痛不适发生率（9．0％）较负性支撑组（16．7％）为低。[结论]内侧皮质正性支撑复位，头颈骨块经过有限的滑动即能获得与股骨干的接触砥着，达到二次稳定坐实，为骨折愈合创造良好的力学条件。[ Objective] To introduce the concept of fracture reduction with positive medial cortical support and its clinical and radiological correlation in geriatric unstable pertrochanteric fractures. [ Method] Retrospective analysis of 127 patients （32 men and 95 women ,with mean age 78.7 years） with AO/OTA 31A2 hip fractures treated with cephalomeduallary nail （PFNA- Ⅱ or Gamma-3 ） between July 2010 and June 2013 was performed. They were classified into three groups according to the grade of medial cortical support （ positive, neutral, or negative ）. The patient demographic baseline, postoperative radiographic femoral neck - shaft angle and neck length, rehabilitation progress and functional recovery scores were recorded and statistically compared. [Result]There were no statistical differences between the three groups among patient age, sex ratio, pre -fracture score of activity of daily living, walking ability score, ASA physical risk score, number of medical eomorbidities, osteoporosis Singh index, fracture reduction quality （ Garden alignments ） and the position of lag screw or helical blade in femoral head （TAD）. In follow-up, patients in positive medial cortical support reduction group had little loss in neck-shaft angle and neck length, and got ground - walking much earlier than those in negative reduction group, with good functional outcomes and less hip- thigh pain presence. [ Conclusion ] Fracture reduction with positive medial cortical support, allows limited sliding of the head- neck fragment to contact with the femur shaft and achieve secondary stability, providing a good mechanical environment for fracture healing.

关 键 词：股骨粗隆间骨折 骨折复位 正性皮质支撑 头髓钉 撑开效应 髋股疼痛 

分 类 号：R687.3[医药卫生—骨科学]