髓内钉附加锁定钢板重建支撑内侧壁治疗股骨粗隆下粉碎骨折的临床应用  

Subtrochanteric fractures： treatment with long intramedullary nail and osteosynthesis with plate systems to restore the medial buttress.

作　　者：宗双乐[1] 苏立新[1] 梁卫东[1] 赵小明[1] 李立东[1] Zong Shuangle;Su Lizin;Liang Weidong;Zhao Xiaoming;Li Lidong(Department of Orthopaedics,the Second Hospital of Tangshan,Tangshan 063000,China)

机构地区：[1]唐山市第二医院创伤骨科,唐山063000

出　　处：《中华解剖与临床杂志》2018年第4期318-322,共5页Chinese Journal of Anatomy and Clinics

摘　　要：目的 探讨髓内钉附加锁定钢板重建支撑内侧壁内固定术治疗股骨粗隆下粉碎骨折的手术方法及临床疗效.方法 回顾性分析2014年9月—2017年1月唐山市第二医院创伤骨科收治的股骨粗隆下骨折26例患者的临床资料.其中男16例、女10例,年龄22～70（40.5±3.5）岁;按股骨粗隆下骨折Seinsheimer标准分型,ⅢA型3例,ⅢB型2例,Ⅳ型16例,V型5例.所有患者采用股骨近端髓内钉附加锁定钢板重建内侧壁支撑固定手术治疗.根据改良Harris标准,从疼痛感受、功能（步态和活动）、与健侧肢体肌力及活动范围对比4个方面进行髋关节功能疗效评定.结果26例患者术后均获得随访,随访时间为12～36（20.5±4.6）个月,均获得骨性愈合,骨折愈合时间为2～6（3.0±0.8）个月.术后12个月随访,无骨折移位、内固定物失效断裂、髋内翻畸形及股骨头坏死等并发症.改良Harris髋关节功能评分为90～120（115.5±10.7）分,其中优21例,良5例.结论 髓内钉中心性固定附加锁定钢板重建支撑股骨内侧壁治疗股骨粗隆下粉碎骨折,可获得最佳生物力学稳定性,骨折复位及固定可靠,骨折愈合率高.Objective To evaluate the effectiveness of the treatment with long intramedullary nail and osteosynthesis with plate systems to reconstruct the medial buttress for the subtrochanteric fractures. Methods A retrospective analysis including 26 patients with subtrochanteric fractures was conducted from September 2014 to January 2017. The data of patients：16 males and 10 females aged 22-70 （40. 5 ± 3. 5） years. All patients were treated with proximal femur long intramedullary nail and osteosynthesis with plate systems to reconstruct the medial buttress for the subtrochanteric fractures. According to the Seinsheimer type of the subtrochanteric fractures. There were 3 cases of typeⅢA, 2 cases of typeⅢB, 16 cases of typeⅣ, and 5 cases of type V. The postoperative X-ray showed that all subtrochanteric fractures of the femur were well restored. The assessment of the Hip function result was obtained according to the modified Harris hip score. It includes pain, function（ gait and activities） , relative strength and relative range of movement. Results All of the 26 patients were followed up from 12 months to 36 months （20. 5 ± 4. 6）. All patients obtained good fracture union. The time of the fracture union ranged from 2 to 6 months （3. 0 ± 0. 8）. No fracture displacement, fixation failure varus mal-reduction and femoral head necrosis occurred after follow-up for 12 months. The modified Harris hip scores were 115. 5 ± 10. 7 （range, 90 -120）, in which 21 were good, 5 were fair. Conclusions The treatment with long intramedullary nail and osteosynthesis with plate systems to reconstruct the medial buttress for the subtrochanteric fractures could obtain biomechanically stability, reliably fixation and highly fracture union.

关 键 词：股骨骨折 骨折 粉碎性 粗隆下骨折 髓内钉 内侧壁 

分 类 号：R687.3[医药卫生—骨科学]