股骨转子间骨折髓内固定复位丢失的预防措施及疗效评价  

Preventive measures and outcome evaluation of reduction loss of intramedullary fixation for femoral intertrochanteric fracture

作　　者：佟大可[1] 刘培钊[1] 丁晨[1] 刘康[1] 贺倩芸 秦升[1] 丁文彬[1] 章浩[1] 吴雪琳[1] 唐昊[1] 纪方[1] Tong Dake;Liu Peizhao;Ding Chen;Liu Kang;He Qianyun;Qin Sheng;Ding Wenbin;Zhang Hao;Wu Xuelin;Tang Hao;Ji Fang(Department of Trauma Orthopaedics, Changhai Hospital, Second Military Medical University, Shanghai 200433, China)

机构地区：[1]第二军医大学长海医院创伤骨科,上海200433

出　　处：《中华老年骨科与康复电子杂志》2017年第4期210-215,共6页Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)

基　　金：上海市科研计划医学重点项目(13411951500)

摘　　要：目的探讨股骨转子间骨折髓内固定复位丢失的原因、预防措施和疗效评价。方法回顾性分析第二军医大学长海医院采取股骨近端髓内钉(PFNAII)治疗的13例术中出现二次复位丢失的股骨转子间骨折患者,分析术中出现复位丢失的原因。术中处理方法:(1)克氏针在主钉位置的前方后方临时固定,然后扩髓;(2)以骨折复位器械把持转子间骨折的骨折端后扩髓。统计患者骨折的分型、手术方法、手术时间、并发症发生率、骨折愈合率、Harris评分。结果术中出现二次复位丢失的13例患者均有以下特点:骨折线通过髓内钉开口,髓内钉开口内侧皮质坚硬;采取本研究中处理方法,13例患者均圆满完成术中操作,手术时间平均(48±6)min,术中出血量(194±10)ml,术后卧床时间(30±3)d,骨折愈合率为100%,无延迟愈合、骨不连,Harris评分:优10例,良3例。结论复位丢失是股骨转子间骨折髓内固定的一个陷阱,对于骨折线经过髓内钉开口且内侧皮质坚硬的患者,采取本研究处理方法可有效预防置钉过程中出现的复位再丢失,从而更好的进行复位固定,获得更好的手术效果。Objective To investigate the causes,preventive measures and outcome evaluation of reduction loss of intramedullary fixation for femoral intertrochanteric fractures.Methods A retrospective study was performed in13cases of femoral intertrochanteric fractures treated by proximal femoral nail(PFNAII)with secondary reduction loss during surgery in changhai hospital(Shang Hai).Reasons for the reduction loss during surgery were evaluated and the following approaches were made:1.Using kirschner wires to temporarily fix the Proximal femur in front or rear of the main nail,and then reaming;2.Using fracture reduction devices to control the intertrochanteric fracture ends,and then reaming.The fracture classification,surgical methods,operation time,the incidence of complications,fracture healing rate and Harris score of all patients were statistically analyzed.Results Thirteen patients with secondary surgical reduction loss had the following characteristics:fracture line pass through the opening site of intramedullary nail and the cortex of medial intramedullary nail was hard.Thirteen patients were successfully completed operative process with our methods.The average operative time was48±6min,the average blood loss was194±10ml,the average postoperative bedtime was30±3d,and fracture healing rate was100%,no delayed healing and non-union occurred.Harris score were:Excellent in10cases,good in3case.Conclusion Reduction loss is a trap of intramedullary fixation for intertrochanteric fractures.For the patients with fracture line pass through the opening site of intramedullary nail and hard medial cortex,our methods can effectively prevent the secondary reduction loss during surgery,obtaining better reduction/fixation and surgical results.

关 键 词：髋骨折 骨折固定术 髓内 复位丢失 

分 类 号：R687.3[医药卫生—骨科学]