皮质内螺钉技术结合有限切开复位治疗老年31A3型难复性股骨粗隆间骨折  

Clinical efficacy of fixation bone fragments by screw though cortical bone tunnel combined with limited open reduction in treating 31A3 type irreducible femoral intertrochanteric fractures in elderly people

作　　者：黄晓文[1] 洪顾麒[1] 凡进[1] 李翔[1] 陈群[1] Huang Xiaowen;Hong Guqi;Fan Jin;Li Xiang;Chen Qun(Department of Orthopedics,the First Affiliated Hospital of Nanjing Medical University(Jiangsu Province Hospital),Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院(江苏省人民医院)骨科,南京210029

出　　处：《中华医学杂志》2020年第9期674-678,共5页National Medical Journal of China

基　　金：江苏省六大人才高峰人才项目(2014-WSN-011)。

摘　　要：目的探讨运用皮质内螺钉技术结合有限切开复位治疗老年31A3型难复性股骨粗隆间骨折的临床疗效。方法回顾性分析2017年7月至2018年6月在江苏省人民医院骨科治疗的18例老年31A3型难复性股骨粗隆间骨折患者的临床资料。其中男8例,女10例,年龄65~88岁,平均(76±4)岁。在术中C臂机透视证实难复性骨折后,均予以皮质内螺钉技术结合骨折端有限切开复位髓内钉内固定治疗,评估手术一般情况,骨折复位质量和髋关节FRS评分等。手术前后数据比较采用配对t检验。结果所有患者均获得随访,时间10~22个月,平均13.6个月。手术时间(55±13)min(42~95min)。术中出血(223±26)ml(180~320ml)。术中平均透视(23±4)次(18~32次)。骨折平均愈合时间(4.8±0.7)个月。Kim骨折复位质量评价,Ⅰ级15例,Ⅱ级3例,全部优良。末次随访时FRS评分(84±10)分,和受伤前[(84±11)分]比较差异无统计学意义(t=0.144,P=0.887)。结论对于老年31A3型难复性股骨粗隆间骨折,运用皮质内螺钉技术结合有限切开复位内固定的方法可获得高质量的骨折复位和固定,且不增加手术时间和出血,具有良好的临床疗效。Objective To explore and analyze the clinical efficacy of fixation bone fragments by screw though cortical bone tunnel combined with limited open reductionin treating 31 A3 type irreducible femoral intertrochanteric fractures in elderly people.Methods Clinical data of 18 elderly patients with 31 A3 type irreducible femoral intertrochanteric fractures treated from July 2017 to June 2018 in Orthopedics Department of Jiangsu Province Hospital were collected and analyzed retrospectively.There were 8 males and 10 females,aged from 65 to 88 years(mean age,(76±4)years).When confirmed as irreducible femoral intertrochanteric fractures by C-arm machine during operation,limited open reduction and fixation bone fragments by screw though cortical bone tunnel and intramedullary nail fixation were conducted.General surgical data,the quality of fracture reduction and functional recovery scale(FRS)score were collected.Data before and after operation were compared with paired i-test.Results All patients were followed up for a mean of 13.6 months(10 to 22 months).The surgical time was(55±13)min(42 to 95 min),the intraoperative blood loss was(223±26)ml(180 to 320 ml),the number of intraoperative fluoroscopy was 23±4(18-32 times),and the fracture healing time was(4.8±0.7)months.The quality of fracture reduction was rated as grade I in 15 cases andgrade U in 3 cases,with an excellent to good rate of 100%according to Kim classification.FRS score was 84±10 at the last follow-up and it was comparable with that before injury(84±11)(t=0.144,P=0.887).Conclusion For elderly patients with 31 A3 type irreducible femoral intertrochanteric fractures,fixation bone fragments by screw though cortical bone tunnel combined with limited open reduction is an efficient treating method with advantages of high quality of fracture reduction and fixation without increasing of surgical time and blood loss.

关 键 词：难复性股骨粗隆间骨折 皮质内螺钉技术 有限切开 老年 

分 类 号：R687[医药卫生—骨科学]