侧卧位髓内钉治疗股骨转子下骨折  

Lateral decubitus intramedullary nailing for femoral subtrochanteric fractures

作　　者：佟大可[1] 魏强[1] 刘培钊 段旭洲 贺倩芸 刘康 秦升 徐凯航 吴雪琳 章浩[1] 唐昊[1] 迪力夏提 纪方[1] Tong Dake;Wei Qiang;Liu Peizhao;Duan Xuzhou;He Qianyun;Liu Kang;Qin Sheng;Xu Kaihang;Wu Xuelin;Zhang Hao;Dilshat;Ji Fang(Department of Orthopedic Trauma,Changhai Hospital,Shanghai 200433,Chin;Brigade 60 of Army Group 86,Central Military Command,Xi＇an 710608,Chin;Hospital of Chinese People＇s Liberation Army,Ningbo 315000,China;Health Company of 73091 Troops,Zhenjiang 212405,China;Synthetic Brigade 138 of Group Army 80,Yantai 265200,China;Department of Orthopedics,Dahua Hospital of Xuhui District,Shanghai 200237,Chin;Department of Orthopedics,People＇s Hospital of Bachu County,Kasha 843800,Chin)

机构地区：[1]上海长海医院创伤骨科,200433 [2]中部战区陆军第83集团军合成第60旅,西安710608 [3]中国人民解放军第113医院浙,江省宁波市315000 [4]73091部队卫生连,江苏省镇江市212405 [5]80集团军合成第138旅,山东省烟台市265200 [6]上海市徐汇区大华医院骨科,200237 [7]新疆巴楚县人民医院骨科,新疆喀什843800

出　　处：《中华创伤骨科杂志》2018年第7期634-638,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨侧卧位时应用髓内钉治疗股骨转子下骨折的技术要点和疗效。方法回顾性分析2012年1月至2015年12月上海长海医院创伤骨科收治的23例单纯股骨转子下骨折患者资料。男15例，女8例；年龄19～77岁，平均48．3岁。骨折Seinsheimer分型：ⅡB型6例，ⅡC型8例；ⅢA型6例，ⅢB型3例。致伤原因：交通伤10例，高处坠落伤5例，扭伤8例。手术均采用侧卧位下闭合复位顺行髓内钉内固定，术后采用常规治疗和护理。记录并分析手术时间、出血量、透视剂量、骨折愈合时间及并发症发生情况。末次随访时按照美国特种外科医院（HSS）功能评分系统评估功能恢复情况。结果本组患者手术时间为55．80min，平均为65．7min；术中出血量为240～420mL，平均304．3mL；透视次数为30～60次，平均42．7次。23例患者术后获12～28个月（平均17．9个月）随访；骨折愈合时间为4～10个月，平均5．5个月。有1例患者发生骨不连，经二次手术后获愈合。末次随访时HSS评分显示：优17例，良6例，优良率为100％。所有患者术后切口均一期愈合，无一例患者发生感染、深静脉血栓形成等；无内固定失败患者。结论采用侧卧位髓内钉固定治疗股骨转子下骨折，可以达到满意的临床效果，这种体位可以作为临床治疗此类骨折的一种有益选择。Objective To investigate the efficacy of lateral decubitus intramedullary nailing for treat- ment of subtrochanteric fractures of the femur. Methods From January 2012 to December 2015, 23 pa- tients with simple femoral subtrochanteric fracture were treated at Department of Orthopedic Trauma, Changhai Hospital. They were 15 males and 8 females, aged from 19 to 77 years （average, 48.3 years）. According to the Seinsheimer classification, there were 6 cases of type ⅡB, 8 cases of type ⅡC, 6 cases of type Ⅲ A, and 3 cases of type ⅢB. Their injuries were caused by traffic accident in 10 cases, falling from a height in 5 cases, and sprain in 8 cases. All patients were treated by closed reduction and anterograde intramedullary nailing at lateral decubitus. Their operative time, bleeding volume, fluoroscopic frequency, fracture healing time, functional recovery and complications were recorded and analyzed. Results Their operative time ranged from 55 to 80 min, averaging 65.7 min; their bleeding volumes ranged from 240 to 420 mL, averaging 304.3 mL; their fluoroscopic frequency ranged from 30 to 60 times, averaging 42.7 times. This cohort was followed up for 12 to 28 months （average, 17.9 months） . Their fracture healing time ranged from 4 to 10 months, averaging 5.5 months. Nonunion occurred in one patient but was cured by secondary operation. The HSS evaluation at the final follow-ups showed 17 excellent cases and 6 good ones, yielding an excellent to good rate of 100%. All the wounds healed by the first intention. No infection, deep vein thrombosis or implant failure was observed. Conclusion As lateral decubitus intramedullary nailing can achieve satisfactory clinical efficacy for sub- trochanteric fractures of the femur, the body position of lateral decubitus may be a good alternative.

关 键 词：体位 骨折固定术 髓内 骨钉 侧卧位 股骨转子下骨折 

分 类 号：R687.3[医药卫生—骨科学]