InterTan髓内钉治疗老年股骨转子间骨折的失败原因分析  

Analysis of failure after treatment of senile femoral intertrochanteric fractures with InterTan nails

作　　者：潘垚[1] 陈云丰[1] 章伟[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：《中华创伤骨科杂志》2014年第8期674-678,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的 观察InterTan髓内钉治疗老年股骨转子间骨折的临床疗效,分析内固定失败的原因并探讨预防方法. 方法 回顾性分析2009年4月至2012年12月采用闭合复位InterTan髓内钉治疗的337例老年股骨转子间骨折患者资料,男189例,女148例;年龄为60～ 87岁,平均69.7岁;骨折按AO分型：A1.1型71例,A1.2型89例,A1.3型78例;A2.1型51例,A2.2型35例,A2.3型7例;A3型6例.观察术中、术后并发症发生情况,分析内固定失败的原因. 结果 3例患者术中发生股骨近端外侧壁骨折,术后延迟负重后骨折获愈合;1例患者术中发现主钉松动,予限制负重后骨折获愈合.205例患者术后获平均2.3年（0.5～4.0年）随访,随访率为60.8％ （205/337）.205例患者中,169例患者骨折获愈合,愈合时间为2.6～3.4个月,平均2.9个月;术后12个月内死亡14例;内固定失败22例（10.7％）：术后3个月时髋内翻畸形6例,其中伴股骨头切出4例;术后6个月时股骨颈短缩2例,髋内翻畸形11例;随访期间3例患者骨折愈合后发生髓内钉尾端股骨干骨折.此22例患者均行翻修术：关节置换5例;更换内固定17例,术后骨折愈合12例,另5例于术后12个月内死亡. 结论 虽然InterTan髓内钉能有效治疗老年股骨转子间骨折,但术中、术后仍不可避免地会出现一些并发症.良好的术中操作是避免内固定失败的关键,术后需密切随访以防止髋内翻畸形、股骨颈短缩及股骨头切出等并发症的出现并及时处理.Objective To analyze the causes for failed treatment of senile patients with femoral intertrochanteric fracture by the InterTan nailing system.Methods We retrospectively analyzed the clinical data of 337 elderly patients who had been treated in our department from April 2009 to December 2012 for femoral intertrochanteric fracture with closed reduction and internal fixation with InterTan nails.They were 189 males and 148 females,60 to 87 years of age （mean,69.7 years）.According to the AO/OTA classification,71 fractures were type A1.1,89 type A1.2,78 type A1.3,51 type A2.1,35 type A2.2,7 type A2.3,and 6 type A3.We observed intraoperative and postoperative complications to analyze the causes for failed internal fixation and their preventive countermeasures.Results Of all the patients,205 were followed up for an average of 2.3 years （from 0.5 to 4.0 years）.The rate of follow-up was 60.8% （205/337）.The fracture healed in 169 out of 205 patients after 2.6 to 3.4 months （average,2.9 months）.Twelve months after operation,14 patients died and fixation failure occurred in another 22 patients （10.7%）.Varus deformity was found 3 months postoperatively in 6 cases,of which 4 were complicated with cutout of a lag screw.At 6 months postoperatively,shortening of the femoral neck was found in 2 cases and varus deformity in 11 cases.After the intertrochanteric fracture healed during follow-up,3 cases of femoral fractures occurred at the end of the nail.We performed revision surgery for all these 22 cases of failed fixation.Arthroplasty was done for 5 cases and fixation was changed for 17 cases.After the revision surgery,fracture healed in 12 cases and 5 cases died within 12 months postoperatively.Conclusions The senile femoral intertrochanteric fractures can be successfully treated by the InterTan nailing system,but intraoperative and postoperative complications are inevitable.Good intraoperative manipulation is the key to preventing failure of the fixation and intensive postoperative follow-up is needed to watc

关 键 词：髋骨折 骨折固定术 髓内 骨钉 老年人 

分 类 号：R683[医药卫生—骨科学]