大转子再结合装置辅助股骨近端防旋髓内钉治疗合并冠状面骨折的不稳定性股骨转子间骨折  

Efficacy of the second generation of proximal femoral nail antirotation assisted with greater trochanteric reattachment in the treatment of unstable intertrochanteric fractures characterized by trochanteric coronal plane fractures

作　　者：杜春雨[1] 林峰[2] 王秋根[1] 杨锡明[2] 伍凯[1] 

机构地区：[1]上海交通大学附属第一人民医院创伤骨科,200080 [2]山东省滕州市中心人民医院骨科,277599

出　　处：《国际骨科学杂志》2017年第1期55-59,共5页International Journal of Orthopaedics

摘　　要：目的评估大转子再结合装置(GTR)辅助第二代股骨近端防旋髓内钉(PFNA-Ⅱ)治疗合并冠状面骨折的不稳定性股骨转子间骨折疗效。方法回顾性分析2012年4月至2015年12月收治的32例合并冠状面骨折的不稳定性股骨转子间骨折患者资料。其中接受GTR辅助PFNA-Ⅱ固定17例(GTR组),女10例,男7例,平均76.3岁;接受单纯PFNA-Ⅱ固定15例(PFNA-Ⅱ组),女6例,男9例,平均81.4岁。观察两组手术时间、术中出血量、骨折愈合时间及并发症情况。术后采用Harris髋关节功能评分进行髋关节功能评估。结果 GTR组手术时间、术中出血量多于PFNA-Ⅱ组。32例患者术后获得平均10.3个月的随访。GTR组平均随访10.7个月(8~12个月),Harris髋关节功能评分优良率为76.5%,所有患者均获得骨性愈合。PFNA-Ⅱ组平均随访11.8个月(9~16个月),Harris髋关节功能评分优良率为40.0%,有1例患者未获得骨性愈合。GTR组患者术后疼痛明显轻于PFNA-Ⅱ组,两组在髋关节功能、畸形、活动范围方面评分结果相近。GTR组有1例术后发生深静脉血栓,PFNA-Ⅱ组有1例术后发生肠梗阻。结论合并冠状面骨折的股骨转子间骨折是一种特殊类型的不稳定性骨折,GTR辅助PFNA-Ⅱ固定较单纯PFNA-Ⅱ固定能提供更好的稳定性,可能是治疗此类骨折的有效方法。Objective To evaluate the efficacy of the second generation of proximal femoral nail antirotation（PFNA-Ⅱ）assisted with greater trochanteric reattachment（GTR）in the treatment of unstable intertrochanteric fractures characterized by coronal plane fractures.Methods In this retrospective study,from April 2012 to December 2015,data of 32 patients suffering unstable intertrochanteric fractures characterized by trochanteric coronal plane fractures were collected.Of the 32 patients,17 patients were fixed with PFNA-Ⅱ assisted with GTR（10females,7 males,mean age 76.3 years）（GTR group）;15 patients were fixed with PFNA-Ⅱ only（6females,9 males,mean age 81.4 years）（PFNA-Ⅱ group）.Surgery duration,bleeding volume,bony healing time and complications were reviewed.All the patients were functionally evaluated according to Harris hip scores.Results Longer surgery duration and more bleeding volume were observed in the GTR group compared with the PFNA-Ⅱ group.The average follow-up for all patients was 10.3 months.For the GTR group with an average followup of 10.7 months（range,8 to 12 months）,76.47% cases achieved good or excellent results,and all fractures healed during the follow-up.For the PFNA-Ⅱ group with an average follow-up of 11.8 months（range,9 to 16 months）,40% of them got good or excellent results,and 1case didn＇t achieve bony healing during the follow-up.The pain scores of the GTR group were higher compared with the PFNA-Ⅱ group.Both groups obtained similar results in the function scores,deformity and range of motion.There was a deep vein thrombosis postoperatively in the GTR group,and an intestinal obstruction in the PFNA-Ⅱ group.Conclusion Intertrochanteric fractures characterized by trochanteric coronal plane fractures are a special type of unstable fractures.Internal fixation with PFNA-Ⅱ assisted with GTR could provide more stability,which may be an effective alternative to this special fractures.

关 键 词：股骨转子间骨折 冠状面骨折 大转子再结合装置 股骨近端防旋髓内钉 

分 类 号：R687.3[医药卫生—骨科学]