基于C形臂股骨颈前倾角测量在股骨中近段骨折闭合复位髓内钉固定术中的旋转控制  

Effects of femoral anteversion measurement by c-arm on antetorsion control deringintramedullary nai fixation in treatment of femoral proximal and middle fractures

作　　者：莫华贵[1] 罗裕强 黄远翘[1] 陈元庄[1] 马滚韶[1] 徐勤[1] 邬黎平[1] MO Huagui;LUO Yuqiang;HUANG Yuanqiao;CHEN Yuanzhuang;MA Gunshao;XU Qin;WU Liping(Trauma and Joint Department,Jiangmen Central Hospital,Jiangmen,Guangdong 529030,China)

机构地区：[1]江门市中心医院四肢关节骨科,广东江门529030

出　　处：《岭南现代临床外科》2018年第2期204-208,共5页Lingnan Modern Clinics in Surgery

基　　金：广东江门市医疗卫生领域科技计划项目(2016020200080000860)

摘　　要：目的探究与评价基于C形臂股骨颈前倾角测量在股骨中近段骨折闭合复位髓内钉固定术中旋转控制的可行性和效果。方法纳入自2015年6月到2017年6月应用闭合复位髓内钉固定术治疗股骨干中近段骨折患者共46例,其中观察组25例采用Brunner提出的C形臂测量患肢股骨颈前倾角进行旋转控制,对照组21例采用常规方法进行旋转控制。所有病例均为单侧闭合性骨折,术前行双侧股骨CT扫描,并测量健侧股骨颈前倾角。术中采用Brunner法,将股骨远端放置标准正位,通过调整近端旋转,将患侧前倾角调整至正常侧的值。所有病例术后行CT扫描并测量患侧股骨颈前倾角。结果所有纳入病例均顺利完成手术,两组手术时间、出血量、骨折愈合时间无统计学意义,两组健侧与患侧股骨颈前倾角差异比较有统计学意义(观察组4.62°±2.35°,对照组7.28°±2.93°,t=3.41,P<0.001)。随访6~24个月,平均16.8个月,未见骨不连、螺钉切出等并发症。术后6个月St.Michael髋关节评分比较有统计学意义(观察组22.2±1.8,对照组20.6±2.0,t=2.86,P=0.01)。结论基于C形臂股骨颈前倾角测量可指导股骨干骨折闭合复位髓内钉固定中骨折端的旋转对位,准确判断股骨近端旋转角度和状态,提高术中的复位效果,明显降低术后旋转对位不良的发生率。Objective To evaluate the feasibility and effectiveness of adjusting mal-rotation based on measurement of femoral neck anteversion using C-arm in intramedullary nail fixation for femoral proximal and middle fractures.Methods A total of 46 patients with femoral proximal and middle fractures were treated with closed reduction and intramedullary nail fixation from June 2015 to June 2017.Twenty-five cases of experimental group were developed according to Brunner method(rotation of femur adjusted based on femoral neck anteversion measurement using C-arm),and conventional methods are adminis-tered in 21 cases of control group for rotation control.A ll cases were unilateral closed fractures.Bilateral femur CT scan was performed before operation,and femoral neck anteversion of the normal side was measured,which was used to adjust the proximal rotation in the standard position of distal femur in experimental group.CT scan was performed post-operation in all cases and the femoral neck anteversion of affected side was measured.Results A ll cases were successfully completed.There was no significant difference in operative time,bleeding volume and fracture healing time between the two groups.The absolute difference of femoral neck anteversion between the normal sand affected side was significantly different(experimental group 4.62°±2.35°vs control group 7.28°±2.93°,P<0.001).Following up 6 to 24months with an average of 16.8 months,no bone nonunion,screw cut and other complications were recorded.The St.Michael hip score of 6 months post-operation was statistically significant(experimental group 22.2+1.8 vs control group 20.6±2.0,P=0.01).Conclusion Measurement of femoral neck antever-sion based on C-arm in intramedullary nail for femoral proximal and middle fractures improves the reduc-tion effect during operation,and significantly reduces the incidence of rotational mal-alignment.

关 键 词：股骨骨折 前倾角 旋转预防 髓内钉 C形臂 

分 类 号：R683.42[医药卫生—骨科学]