闭合或有限切开复位髓内钉固定治疗SeinsheimerⅤ型股骨转子下骨折疗效分析  

Effectiveness analysis of closed or limited open reduction and intramedullary nail fixation in treatment of Seinsheimer typeⅤsubtrochanteric fracture

作　　者：姚晓克[1] 伍玲娜 李建华[1] 黄文刚[1] 段鑫[1] 顾祖超[1] 王跃[3] YAO Xiaoke;WU Lingna;LI Jianhua;HUANG Wengang;DUAN Xin;GU Zuchao;WANG Yue(Department of Orthopedics,Chengdu First People’s Hospital,Chengdu Sichuan,610041,P.R.China;Department of Intensive Care Unit,Chengdu First People’s Hospital,Chengdu Sichuan,610041,P.R.China;Department of Orthopedics,Sichuan Academy of Medical Science·Sichuan Provincal People’s Hospital,Chengdu Sichuan,610072,P.R.China)

机构地区：[1]成都市第一人民医院骨科,成都610041 [2]成都市第一人民医院重症医学科,成都610041 [3]四川省医学科学院·四川省人民医院骨科,成都610072

出　　处：《中国修复重建外科杂志》2020年第4期457-462,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：四川省医学科研课题计划(S18059)。

摘　　要：目的探讨闭合或有限切开复位髓内钉固定治疗SeinsheimerⅤ型股骨转子下骨折的疗效。方法2014年5月—2018年7月,采用闭合或有限切开复位髓内钉固定治疗36例SeinsheimerⅤ型股骨转子下骨折患者。男25例,女11例;年龄23~86岁,平均55.8岁。致伤原因:摔伤19例,交通事故伤9例,高处坠落伤7例,重物砸伤1例;均为新鲜闭合性损伤。受伤至手术时间1~14 d,平均6.8 d。术中闭合复位18例,有限切开复位18例;采用股骨重建髓内钉固定17例,InterTan长钉固定5例,加长型股骨近端防旋髓内钉固定14例,辅助钢丝捆扎7例。术后通过X线片和临床随访,判断骨折复位维持情况、内固定物位置、骨折愈合情况;观察髋关节活动范围、行走能力及并发症发生情况,根据Merle d’Aubigne-Postel髋关节评分标准评价髋关节功能。结果术后患者髋部手术切口均Ⅰ期愈合,无血管、神经损伤及感染等并发症发生。患者均获随访,随访时间12~24个月,平均14.2个月。1例患者闭合复位术后2个月出现股骨头内翻移位、螺钉穿出现象,给予翻修手术,髋关节功能恢复稍差。其余患者术后X线片示骨折均愈合,愈合时间9~15个月,平均11.5个月;随访期间未出现内固定失效、骨折再移位、骨不连、畸形愈合、下肢深静脉血栓形成等并发症;髋关节功能恢复良好,能够正常行走、下蹲,不影响日常生活或工作。末次随访时,根据Merle d’Aubigne-Postel髋关节评分标准评价,获优28例,良4例,中3例,差1例,优良率88.9%。结论C臂X线机透视下闭合或有限切开复位髓内钉固定治疗SeinsheimerⅤ型股骨转子下骨折,必要时辅助钢丝捆扎,具有骨折端血供破坏少、复位满意、固定牢靠及利于早期康复训练等优点,疗效确切。Objective To investigate the effectiveness of closed or limited open reduction and intramedullary nail fixation in the treatment of Seinsheimer typeⅤsubtrochanteric fracture.Methods Between May 2014 and July 2018,36 patients with Scinsheimer typeⅤsubtrochanteric fractures were treated with closed or limited open reduction and intramedullary nail fixation.There were 25 males and 11 females with an age of 23-86 years(mean,55.8 years).The cause of injury included falling in 19 cases,traffic accident in 9 cases,falling from height in 7 cases,and heavy object injury in 1 case;all were fresh closed injuries.The interval between injury and operation was 1-14 days(mean,6.8 days).There were 18 cases of closed reduction and 18 cases of limited open reduction during the operation.Seventeen cases were fixed with femoral reconstruction intramedullary nail,5 with InterTan long nail,14 with lengthened proximal femoral nail antirotation,and 7 cases were assisted with auxiliary steel wire binding.After operation,through X-ray film and clinical follow-up,the fracture reduction and maintenance status,internal fixation position,and fracture healing were judged;the range of motion,walking ability,and complications of hip joint were observed,and the function of hip joint was evaluated according to Merle d’Aubigne Postel hip joint scoring standard.Results All the incisions of medullary operation healed by first intention,and no vascular,nerve injury,or infection occurred.All patients were followed up 12-24 months,with an average of 14.2 months.Among the 36 patients,1 patient received revision surgery due to varus displacement of femoral head and screw penetration at 2 months after closed reduction,with poor recovery of hip function.X-ray film re-examination showed that the fractures of the other 35 patients healed after 9-15 months,with an average of 11.5 months.During follow-up,there was no complication such as internal fixation failure,fracture redisplacement,bone nonunion or malunion,and deep vein thrombosis of lower extremity

关 键 词：股骨转子下骨折 髋关节 SeinsheimerⅤ型 闭合复位 有限切开复位 髓内钉 内固定 

分 类 号：R687.3[医药卫生—骨科学]