俯卧位自然复位法在髓内钉固定治疗股骨转子下骨折中的应用  

Natural reduction at prone position in treatment of femoral subtrochanteric fractures with intramedullary nailing

作　　者：朱剑津[1] 潘勇卫[1] 何大炜[1] 邓玖征[1] 赵喆[1] Zhu Jianjin;Pan Yongwei;He Dawei;Deng Jiuzheng;Zhao Zhe(Orthopaedic Department,Beijing Tsinghua Changgung Hospital,Tsinghua University,Beijing 102218,China)

机构地区：[1]清华大学附属北京清华长庚医院骨科,清华大学临床医学院,北京102218

出　　处：《中华创伤骨科杂志》2020年第3期218-223,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨俯卧位自然复位法在髓内钉固定治疗股骨转子下骨折中的应用效果。方法回顾性分析2016年8月至2018年4月期间清华大学附属北京清华长庚医院骨科收治的7例股骨转子下骨折患者资料。男4例,女3例;年龄为31~87岁,平均55.6岁;左侧3例,右侧4例;骨折按Seinsheimer分型:Ⅱ型3例,Ⅲ型2例,Ⅴ型2例;受伤至手术时间为9~44 h,平均26 h。所有患者均采用俯卧位自然复位法髓内钉固定治疗。记录患者的术前准备时间、复位所需时间、总手术时间、导针置入透视次数、复位透视次数、总透视次数、复位质量、并发症发生情况及疗效等。结果7例患者均成功完成闭合复位髓内钉内固定。7例患者的术前准备时间平均为29.4 min(21~42 min);复位时间平均为6.3 min(3~10 min),总手术时间平均为157 min(82~275 min)。透视次数:导针置入平均37次(14~96次),复位平均23次(10~49次),合计244次(121~360次)。骨折复位质量按改良Baumgaetner复位标准评定:优6例,可接受1例。7例患者术后获12~34个月(平均20.1个月)随访。1例患者术中发生交锁钉孔处钻头折断,1例患者住院期间发生下肢深静脉血栓形成,1例患者术后发生骨折不愈合;其余患者未发生俯卧位相关并发症。末次随访时按髋关节Harris评分标准评定疗效:优4例,良2例,可1例。结论髓内钉固定治疗股骨转子下骨折时应用俯卧位自然复位法有利于骨折复位及维持复位,术中透视方便,且进针点不受患者肥胖影响,具有良好的应用价值。Objective To evaluate natural reduction at prone position in the treatment of femoral subtrochanteric fractures with intramedullary nailing.Methods The clinical data of 7 patients with subtrochanteric fracture were retrospectively analyzed who had been treated at Orthopaedic Department,Beijing Tsinghua Changgung Hospital from August 2016 to April 2018.They were 4 males and 3 females,aged from 31 to 87 years(average,55.6 years).Their fractures happened on the left side in 3 patients and on the right side in 4.By the Seinsheimer classification,there were 3 cases of typeⅡ,2 cases of typeⅢand 2 cases of typeⅤ.The time from injury to surgery ranged from 9 to 44 hours,averaging 26 hours.All patients were treated by intramedullary nailing after natural reduction at prone position.Their preoperative preparation time,time required for reduction,total operation time,fluoroscopic frequency for guide pin insertion,fluoroscopic frequency for reduction,reduction quality,complications and curative effect were recorded.Results Closed reduction and intramedullary nail fixation were completed uneventfully in all the 7 cases.Their preoperative preparation time averaged 29.4 min(from 21 to 42 min),reduction time 6.3 min(from 3 to 10 min),and total operation time 157 min(from 82 to 275 min).Their fluoroscopic frequency averaged 37 times(from 14 to 96 times)for guide pin insertion and 23 times(from 10 to 49 times)for reduction,totaling 244 times(from 121 to 360 times).According to the modified Baumgaetner criteria,the fracture reduction was evaluated as excellent in 6 cases and as fair in one.The 7 patients were followed up for 12 to 34 months(mean,20.1 months).A drill broke at the interlocking nail hole during operation in one patient,deep venous thrombosis occurred at a lower extremity in another during hospitalization,and fracture nonunion was observed after operation in another,but no complications related to the prone position were observed.The curative effect evaluated by Harris hip score at the last follow-up was excellen

关 键 词：髋骨折 骨折固定术 髓内 骨钉 复位 俯卧位 

分 类 号：R687[医药卫生—骨科学]