股骨近端防旋髓内钉治疗股骨转子间冠状位骨折的手术复位探讨  

Reduction techniques in treatment of coronal femoral intertrochanteric fractures with proximal femoral nail antirotation

作　　者：刘杰[1] 李少华[1] 李振华[1] 王建广[1] 杨春喜[1] 孙业青[1] 吴众[1] 陈栋[1] 

机构地区：[1]同济大学附属第十人民医院骨科、上海市创伤急救中心,上海200072

出　　处：《中华创伤骨科杂志》2014年第8期662-667,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的 探讨股骨近端防旋髓内钉（PFNA）治疗股骨转子间冠状位骨折的手术复位技巧.方法 回顾性分析2008年3月至2012年8月期间采用手术治疗的45例股骨转子间冠状位骨折（不同程度前后向移位）患者资料,根据复位方式不同分为2组：闭合复位组22例,男5例,女17例;平均年龄为（81.1±13.6）岁;行闭合复位.切开复位组23例,男7例,女16例;平均年龄为（78.6±12.3）岁;采用有限切开克氏针撬拨或复位钳钳夹等方式复位.所有患者均采用PFNA内固定.比较两组患者的术中出血量、手术时间、住院时间、骨折愈合时间、术后并发症发生率及末次随访时髋关节Harris评分等.结果 42例患者（闭合复位组与切开复位组各21例）术后获12 ～40个月（平均19.6个月）随访.切开复位组患者的术中出血量[（365.6±89.1）mL]明显多于闭合复位组[（221.3±105.0） mL],手术时间[（64.5±14.2） min]明显长于闭合复位组[（53.6±6.5） min],但术后并发症发生率（0）较闭合复位组低[23.8％ （5/21）],两组比较差异均有统计学意义（P＜0.05）.但两组患者的住院时间、骨折愈合时间及末次随访时髋关节Harris评分等比较差异均无统计学意义（P＞0.05）. 结论 股骨转子间冠状位骨折闭合复位常较困难,采用有限切开克氏针撬拨或复位钳钳夹等复位方式可以有效纠正内翻移位及向前、向后成角移位,提高骨折复位质量,减少术后并发症的发生,且不影响临床疗效.Objective To explore the reduction techniques in the treatment of coronal femoral intertrochanteric fractures with proximal femoral nail antirotation （PFNA）.Methods A retrospective study was performed of the 45 patients with unstable coronal femoral intertrochanteric fracture who had been treated with reduction and osteosynthesis at our department from March 2008 to August 2012.Of them,22 cases received closed reduction,including 5 males and 17 females with a mean age of 81.1 ± 13.6 years; 23 cases received limited open reduction with Kirschner wire prying or forceps clamping,including 7 males and 16 females with a mean age of 78.6 ± 12.3 years.All the patients were fixated with PFNA.The 2 groups were compared in terms of operation time,blood loss,hospital stay,time of fracture healing,complications and Harris hip score at the last follow-up.Results Of this series,42 patients were followed up （21 in each group） for 12 to 40 months （average,19.6 months）.The open reduction group had significantly greater blood loss （365.6 ± 89.1 mL）,significantly longer operation time （64.5 ± 14.2 min） and a significantly lower rate of complications （0） than the closed reduction group （221.3 ± 105.0 mL,53.6 ± 6.5 min and 23.8% respectively） （P 〈 0.05）.However,there were no significant differences between the 2 groups regarding hospital stay,time of fracture healing or Harris hip score at the last follow-up （P 〉 0.05）.Conclusions As it is difficult to perform closed reduction for coronal intertrochanteric fractures,limited open reduction may be preferable in most of the cases because it can improve reduction and decrease incidence of postoperative complications by effectively correcting displacements caused by varus and anterior or posterior angulation.

关 键 词：髋骨折 骨折固定术 髓内 骨钉 

分 类 号：R687.3[医药卫生—骨科学]