带前弓弧度短型股骨转子间髓内钉的研制及其匹配性的术后影像学研究  

IMAGING STUDY ON DESIGN AND GEOMETRIC MATCH OF A NEW TYPE OF SHORT FEMORAL INTERTROCHANTERIC NAIL WITH ANTERIOR CURVATURE

作　　者：张世民[1] 张英琪[1] 胡孙君[1] 马卓[1] 姚勐炜[1] 姚喜洲 

机构地区：[1]同济大学附属杨浦医院骨科,上海200090

出　　处：《中国修复重建外科杂志》2016年第10期1200-1204,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：上海市科委医学引导类基金资助(14411971900)~~

摘　　要：目的 研制一种新型带前弓弧度的短型股骨转子间髓内钉（简称新型头髓钉）,观测其与国人股骨髓腔的匹配性。方法 设计一种新型头髓（钉长195 mm,前弓弧度半径120 cm）,并采用前瞻性研究,对2015年11月-2016年6月收治的25例老年股骨转子间骨折患者采用该新型头髓钉治疗。其中男7例,女18例;年龄65~94岁,平均82.3岁。骨折按AO/OTA分型：A1.2型3例,A1.3型2例,A2.1型5例,A2.2型8例,A2.3型7例。受伤至手术时间2~7 d,平均3.2 d。收集患者术中透视像及术后股骨近端正侧位X线片,观测髓内钉在矢状面的入钉点位置（分偏前、居中、偏后3种）,远端钉尖与股骨前侧皮质的关系（按6级分类法）,近端钉尾与大转子外侧皮质的关系（按3级分类法）。结果 1例因术后窒息住院死亡。余均获随访,随访时间1~8个月,平均4个月,其中7例随访时间超过6个月。骨折愈合时间6~10周,平均8周。末次随访时采用Parker-Palmer活动能力评分为4~8分,平均5.5分。无髋股部疼痛主诉。影像学参数测量结果示,髓内钉的矢状面入钉点偏前2例（8%）,居中18例（72%）,偏后5例（20%）。远端钉尖位于髓腔中央者（0级）15例（60%）,偏前但与前侧皮质无接触者（＋1级）8例（32%）,偏后但与后侧皮质无接触者（—1级）1例（4%）,偏前与前侧皮质接触轻度撞击者（＋2级）1例（4%）。近端钉尾不突出大转子外侧皮质者（0级）13例（52%）,突出高度≤5 mm者（1级）9例（36%）,〉5 mm者（2级）3例（12%）。结论 新型头髓钉与国人股骨具有良好的形态学匹配性,钉尖撞击前侧皮质与钉尾突出大转子的出现率很低,有助于减少器械并发症的发生。Objective To design a new type of short femoral intertrochanteric nail （FITN） with anterior curvature （19.5 cm in length and 120 cm in radius） and observe the geometric match with medullary cavity of the femur. Methods Between November 2015 and June 2016, 25 geriatric patients with femoral intertrochanteric fractures were treated with the newly designed FITN. There were 7 males and 18 females with an average age of 82.3 years （range, 65-94 years）. According to AO/OTA fracture classification, 3 cases were rated as A1.2, 2 cases as A1.3, 5 cases as A2.1, 8 cases as A2.2, and 7 cases as A2.3. The interval between injury and operation was 3.2 days （range, 2-7 days）. Postoperatively, the nail entry point position （anterior, central, and posterior） on sagittal plane, the nail tip position （6-grade scale） and the nail tail level （3-grade scale） were measured using fluoroscopy and X-ray films to evaluate the geometric match of the nail with medullary cavity of the femur. Results One patient with Parkinson disease died of asphyxia and pulmonary infection. The other 24 patients were followed up 1-8 months （mean, 4 months）. Fracture union time was 6-10 weeks （mean, 8 weeks）. The mean Parker-Palmer mobility score was 5.5 （range, 4-8）. No patient had hip-thigh pain. The nail entry point was positioned anterior in 2 cases （8%）, central in 18 cases （72%）, and posterior in 5 cases （20%）. The distal nail tip located at the central canal axis （grade 0） in 15 cases （60%）, at anterior without contact with the anterior inner cortex （grade 1） in 8 cases （32%）, at posterior （grade -1） in 1 case （4%）, and at anterior with slight nail-tip impingement with the anterior cortex （grade 2） in 1 case （4%）. The proximal nail tail level did not protrude out beyond the greater trochanter （grade 0） in 13 cases （52%）, protruded out less than 5 mm （grade 1） in 9 cases （36%）, and more than 5 mm （grade 2） in 3 cases （12%）. Conclusion The newly d

关 键 词：股骨转子间骨折 短型头髓钉 股骨前弓 形态匹配性 钉尖撞击 钉尾突出 

分 类 号：R687.33[医药卫生—骨科学]