经皮撬拨复位结合髓内钉内固定治疗难复性股骨粗隆间骨折的疗效观察  

Clinical results of intramedullary nail with assisted reduction technology for the treatment of irreducible femoral intertrochanteric fracture

作　　者：江涛 高涵[2] 刘涛 亢世杰 鲍飞龙 黄东生 胡义明 Jiang Tao;Gao Han;Liu Tao;Kang Shijie;Bao Feilong;Huang Dongsheng;Hu Yiming(Department of Orthopedics,Qilu Hospital of Shandong University(Qingdao),Shandong Qingdao 266000,China;Department of Pathology,Qingdao Municipal Hospital,Shandong Qingdao 266000,China)

机构地区：[1]山东大学齐鲁医院(青岛)创伤骨科,山东青岛266000 [2]山东省青岛市市立医院病理科,山东青岛266000

出　　处：《中国医刊》2020年第6期624-628,共5页Chinese Journal of Medicine

基　　金：青岛市医疗卫生重点学科建设项目(QDZDXK-A-2017005)。

摘　　要：目的探讨经皮撬拨复位结合髓内钉内固定治疗难复性股骨粗隆间骨折的临床疗效。方法选择2013年12月至2015年7月山东大学齐鲁医院(青岛)创伤骨科收治的26例难复性股骨粗隆间骨折患者,均利用骨膜剥离器等辅助器械复位骨折后以髓内钉进行固定。记录手术时间、失血量、并发症发生情况等,并分别于术后3个月、1年、2年对患者进行定期随访,采用Zuckerman髋部骨折功能恢复量表(functional recovery scale,FRS)和欧洲五维健康量表(Euro-quality of life-5 dimension,EQ-5D)评估手术疗效。结果26例患者手术时间为65~120min,平均(89.2±16.4)min,住院时间7~17d,平均(10.3±2.8)d,围术期总失血量632~1320ml,平均(983.9±260.4)ml。所有患者术后均达到骨性愈合,无延迟愈合、不愈合,无髋内翻畸形、股骨头切割等并发症发生。末次随访时患者FRS评分由术前的(93.3±5.7)分降至(81.5±18.5)分,EQ-5D指数由术前的0.95±0.05降为0.86±0.14,差异均有显著性(P<0.05)。结论经皮撬拨复位结合髓内钉内固定治疗难复性股骨粗隆间骨折具有创伤小、复位满意等优点,可取得良好的手术疗效,值得临床应用。Objective To evaluate the clinical effect of intramedullary nail for the treatment of irreducible femoral intertrochanteric fracture.Method Twenty-six elderly patients with irreducible femoral intertrochanteric fracture were included in this study from December 2013 to July 2015.There were 10 male and 16 female with average age of(63.5±19.1)years old.According to Evans-Jensen classification there were 19 cases with III type,10 cases with IV type and 4 cases with V type.All the fracture was reduced with the periosteal dissector through mini-incision and fixed by the intramedullary nail.The data related to surgery and hospitalization were recorded for each patient,while the functional recovery scale(FRS)and EuroQol 5 dimensions index(EQ-5D)were applied to evaluate the clinical effect.Result All the patients were followed up for 2 years.The mean operation time was(89.2±16.4)min,the total blood loss was(983.9±260.4)ml and the bed days were 10.3±2.8.All the fractures were completed union and no patients complicated with nonunion,delayed union and coxa vara.At the last follow-up the FRS scores were decreased from preoperative 93.3±5.7 to postoperative 81.5±18.5(P<0.05),and the EQ-5D index were decreased from preoperative 0.95±0.05 to postoperative 0.86±0.14(P<0.05).Conclusion Mini-incision assisted reduction with intramedullary nail was an effective method for irreducible femoral intertrochanteric fracture,and most of patients can receive reliable clinical outcome with less trauma.

关 键 词：股骨骨折 骨折内固定术 复位 临床疗效 

分 类 号：R683.42[医药卫生—骨科学]