髓内钉治疗复杂不稳定型股骨转子间骨折的经验总结  

Treatment of unstable intertrochanteric fracture with intramedullary nails

作　　者：张晟[1] 杨俊[1] 胡岩君[1] 陈滨[1] 郭刚[1] 冯卫[1] 余斌[1] 

机构地区：[1]南方医科大学南方医院创伤骨科,广州510515

出　　处：《中华创伤骨科杂志》2015年第11期958-961,共4页Chinese Journal of Orthopaedic Trauma

基　　金：广东省医学科学技术研究基金（A2013460）;2013南方医科大学科研启动项目（201322）

摘　　要：目的总结分析髓内钉治疗复杂不稳定型股骨转子间骨折的效果及经验。方法回顾性分析2010年7月至2013年1月期间收治的32例复杂不稳定型股骨转子间骨折患者资料，男13例，女19例；年龄为54～89岁，平均68．7岁。骨折AO分型：31-A2．3型18例，31-A3．3型14例。所有患者均采用股骨近端防旋髓内钉或InterTAN髓内钉固定。记录患者的手术时间、术中出血量、并发症发生情况、骨折愈合时间、尖顶距、术后1年健康调查简表（SF-36）评分及末次随访时髋关节Harris评分等，综合分析髓内钉治疗复杂不稳定型股骨转子间骨折的效果及经验。结果本组患者手术时间平均为63．3min（42．93min），术中出血量平均为263mL（137～646mL）。30例患者术后获平均16．7个月（12．38个月）随访，2例患者于术后12个月内死亡。30例患者术后均获骨性愈合，平均愈合时间为8．2个月（6～12个月）。尖顶距平均为19．8mm（15～28mm）。术后12个月30例患者SF-36评分较术前明显改善。末次随访时30例患者髋关节Harris评分平均为83．6分（71～92分）。无髓内钉断裂、髋内翻畸形、塌陷、股骨头切割及骨不连等并发症发生。结论对于复杂不稳定型股骨转子间骨折，术前需充分理解骨折的移位机制，测量患者的解剖学参数，选择正确的内固定物；术中使用多种复位工具辅助复位可提高手术疗效。Objective To summarize our clinical experience in treatment of unstable in- tertroehanteric fractures with intramedullary nails. Methods From July 2010 to January 2013, 32 unstable intertrochanteric fractures were treated at our department. They were 13 men and 19 women, aged from 54 to 89 years （average, 68.7 years）. By AO classification, 18 cases were type 31-A2.3 and 14 type 31-A3.3. They were all treated with either proximal femoral nails anti-rotation （PFNA） or InterTAN intramedullary nails. The intro-operative blood loss, operation time, complications, healing time, tip-apex distance （TAD）, Harris and SF-36 scores one year postoperation were recorded for analysis. Results In this series, the operation time averaged 63.3 minutes （range, from 42 to 93 minutes）, and the blood loss 263 mL （range, from 137 to 646 mL）. Thirty patients obtained an average follow-up of 16. 7 months （range, from 12 to 38 months）, and 2 died within 12 months postoperation. The 30 patients achieved bony union after an average of 8.2 months （range, from 6 to 12 months） . The TAD averaged 19.8 mm （range, from 15 to 28 mm）. The SF-36 scores one year postoperation for the 30 patients were significantly improved compared to the preoperation. The average Harris score one year postoperation for the 30 patients was 83.6 points （range, from 71 to 92 points）. No such complications as implant failure, hip varus, collapse, femoral cut-off and nonunion occurred. Conclusions In dealing with complex unstable intertrochanteric fractures, it is advisable to make better understanding of the displacement mechanism of the fracture with the aid of CT scan and choose a suitable implant according to the anatomic parameters of the patient. A variety of instruments may help improve the quality of reduction, leading to better surgical outcomes.

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]