加长Gamma3钉结合钛缆固定治疗SeinsheimerⅢ型老年股骨转子下骨折  

Treatment of Seinsheimer type Ⅲ subtrochanteric femoral fractures with prolonged Gannna3 nails and titanium wire fixation in the aged patients

作　　者：熊文 陈明[1] 郑琼[1] 

机构地区：[1]华中科技大学同济医学院附属普爱医院骨科,武汉430033

出　　处：《中华创伤骨科杂志》2018年第1期33-37,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨加长Gamma3钉结合钛缆固定治疗SeinsheimerⅢ型老年股骨转子下骨折的疗效。方法回顾性分析2014年10月至2015年12月期间采用加长Gamma3钉结合钛缆固定治疗的23例SeinsheimerⅢ型股骨转子下骨折患者资料。男7例，女16例；年龄为62～78岁，平均69．3岁。骨折按Seinsheimer分型：ⅢA型14例，ⅢB型9例。受伤至手术时间平均为3．4d（2～6d）。记录患者的手术时间、术中出血量、住院时间、骨折愈合时间及末次随访时患髋功能等。结果本组患者的手术时间平均为1．3h（1．0～1．6h），术中出血量平均为161mL（115—215mL），住院时间平均为10．7d（9～12d）。23例患者术后获5—12个月（平均9．3个月）随访。所有患者骨折均获骨性愈合，愈合时间平均为15．4周（12～20周）。末次随访时根据髋关节Harris评分系统评定息髋功能：优15例，良5例，可3例，优良率为87．0％。随访期间无一例患者发生下肢深静脉血栓形成、脂肪栓塞、髋内翻畸形、再次骨折、拉力螺钉切割股骨头及断钉等并发症。结论加长Gamma3钉结合钛缆固定治疗SeinsheimerⅢ型老年股骨转子下骨折具有手术创伤小、固定坚强、骨折愈合率高及并发症少等优点，可提高远端锁定钉的置入准确性，缩短手术时间，且患者功能恢复良好。Objective To investigate the treatment of subtrochanteric femoral fractures of Seinsheimer type m with prolonged Gamma3 nails and titanium wire fixation in the aged patients. Methods From October 2014 to December 2015, 23 old patients with subtrochanteric femoral fracture were treated with prolonged Gamma3 nails and titanium wire fixation. They were 7 men and 16 women, aged from 62 to 78 years （69.3 years on average）. By Seinsheimer classification, 14 cases were type ⅢA and 9 type ⅢB. The time from injury to surgery averaged 3.4 days （from 2 to 6 days）. Their operation time, intraoperative bleeding, hospital stay, fracture union time and hip function at the final follow-up were documented. Results Their operation time averaged 1.3 hours （from 1.0 to 1.6 hours）, intraoperative bleeding 161 mL （from 115 to 215 mL）, and hospital stay 10. 7 days （from 9 to 12 days）. They obtained follow-ups from 5 to 12 months （9.3 months on average）. All the fractures achieved bony union after an average of 15.4 weeks （from 12 to 20 weeks）. The function of the affected hip assessed at the final follow-up according to the Harris scoring was excellent in 15 cases, good in 5 and fair in 3, resulting in an excellent to good rate of 87.0%. Their follow-ups revealed no deep venous thrombosis of lower limb, fat embolism, coxa vara, refracture, cut-in of the femoral head by the lag screw, or implant breakage. Conclusions In the treatment of senile subtrochanteric femoral fractures of Seinsheimer type Ⅲ, prolonged Gamma3 nails and titanium wire fixation exhibits advantages of limited operative trauma, rigid fixation, a high rate of union and limited complications. Additionally, this treatment can increase the accuracy of inserting distal locking nails, shorten operation time and improve functional recovery.

关 键 词：股骨骨折 骨折固定术 内 骨钉 钛缆 

分 类 号：R687.3[医药卫生—骨科学]