重建外侧壁及股骨矩治疗Evans-JensenⅤ型股骨转子间骨折的疗效分析  

Clinical analysis of reconstruction of lateral wall and femoral moment in the treatment of Evans Jensen type Ⅴ intertrochanteric fracture

作　　者：陈志祥 王传功[1] CHEN Zhi-xiang;WANG Chuan-gong(Huaiyin Hospital of Huai’an City,Huai’an 223300,Jiangsu,China)

机构地区：[1]淮安市淮阴医院,江苏淮安223300

出　　处：《中国骨伤》2020年第11期1053-1057,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)及重建钛板重建外侧壁及股骨矩治疗Evans-JensenⅤ型转子间骨折的手术疗效。方法:分析自2013年10月至2016年3月采用手术治疗的股骨转子间Evans-JensenⅤ型骨折患者30例。按手术方式分为两组:16例行闭合复位PFNA内固定(闭合复位组);14例行小切口切开重建钛板重建股骨矩及外侧壁PFNA内固定(切开复位组)。观察比较两组患者手术中(失血量、手术持续时间)、手术后康复(手术后下床活动时间、骨性愈合时间)、手术相关并发症(内固定断裂、退出、螺旋刀片切出),术后12个月行髋关节功能Harris评分,观察比较颈干角丢失度数。结果:30例患者均获随访,时间12~18个月。所有患者骨折顺利愈合,切开复位组患者手术失血量、手术持续的时间均明显大于闭合复位组(P<0.05)。切开复位组患者手术后下床活动时间、骨性愈合时间、手术相关并发症情况、术后12个月髋关节功能Harris评分、颈干角丢失度数均优于闭合复位组(P<0.05)。结论:使用重建钛板对股骨矩及外侧壁进行复位和固定,PFNA髓内固定治疗Evans-JensenⅤ型的转子间骨折,能够恢复股骨矩及外侧壁对股骨头颈的支撑,有利于提高手术以后骨折断端及内固定的稳定性,减少单独采用PFNA治疗以后骨折断端移位、内固定松动、切出甚至断裂等风险。缩短老年患者卧床时间,减少手术相关的并发症,为Evans-JensenⅤ型股骨转子间骨折的治疗提供新的思路和方法。Objective:To investigate the clinical effect of proximal femoral nail anti rotation(PFNA) and titanium plate in the treatment of Evans Jensen type Ⅴ intertrochanteric fractures. Methods:From October 2013 to March 2016,30 patients with Evans Jensen type Ⅴ intertrochanteric fractures were analyzed. According to the operation methods,they were divided into two groups:16 cases of closed reduction and PFNA internal fixation;14 cases of small incision incision reconstruction of titanium plate reconstruction of femoral moment and lateral wall PFNA internal fixation. The operation(blood loss,operation duration),postoperative rehabilitation(postoperative ambulation time,bone healing time),operation related complications(internal fixation fracture,withdrawal,spiral blade cutting out) were observed and compared between the two groups. Harris score of hip joint function was performed 12 months after operation,and the loss degree of cervical trunk angle was observed and compared. Results:All the 30 patients were followed up for 12 to 18 months. The blood loss and operation duration of open reduction group were significantly greater than those of closed reduction group(P<0.05). The postoperative ambulation time,bone healing time,operation related complications,Harris score of hip joint function and loss of cervical trunk angle in the open reduction group were better than those in the closed reduction group(P<0.05). Conclusion:Evans Jensen was treated with PFNA intramedullary fixation through reduction and fixation of femoral moment and lateral wall with reconstruction titanium plate Vtype intertrochanteric fracture can restore the support of femoral moment and lateral wall to femoral head and neck,improve the stability of fracture end and internal fixation after operation,and reduce the risk of fracture end displacement,internal fixation loosening,cutting out and even fracture after treatment with PFNA alone. To shorten the bed time of elderly patients and reduce the operation related complications,it provides a new idea a

关 键 词：股骨骨折 髋骨折 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]