有限切开复位髓内外联合固定技术治疗股骨转子下骨折的临床随访  

Clinical effectiveness of less invasive intramedullary nail fixation combined with titanium cable cerclage for subtrochanteric fractures

作　　者：刘中砥[1] 许庭珉 党育[1] 张殿英[1] 付中国[1] LIU Zhong-di;XU Ting-min;DANG Yu;ZHANG Dian-ying;FU Zhong-guo(Trauma Medicine Center, Department of Trauma and Orthopaedics, Peking University People’ s Hospital, Beijing 100044, China)

机构地区：[1]北京大学人民医院创伤救治中心,北京大学人民医院创伤骨科,北京100044

出　　处：《北京大学学报（医学版）》2020年第6期1102-1106,共5页Journal of Peking University:Health Sciences

基　　金：教育部长江学者和创新团队发展计划(IRT_16R01);北京大学医学部学院建设项目(BMU2019XY007-01)。

摘　　要：目的:探讨有限切开辅助复位下钛缆环扎联合髓内钉固定治疗股骨转子下骨折的手术技术及临床疗效。方法:回顾性分析2015年1月至2017年12月期间46例股骨转子下骨折患者病例资料,其中男性14例,女性32例;年龄44~92岁,平均(77.83±10.66)岁;左侧17例,右侧29例,致伤原因包括高处坠落、交通事故及意外跌倒。按照Seinsheimer分型:ⅢA型26例,ⅢB型11例,Ⅳ型9例,均为闭合性损伤。所有患者采用有限切开辅助复位下钛缆环扎联合髓内钉固定的方法进行治疗。记录手术时间、出血量、骨折愈合时间等数据,分别采用Sanders创伤性髋关节功能评分、Harris评分等指标评价术后康复效果。结果:46例患者均获得随访,时间12~36个月,平均28个月。所有患者均获得骨性愈合,愈合时间3~6个月。平均手术时间(131.09±20.36)min,平均术中失血量(191.96±111.03)mL,平均住院天数(10.61±2.85)d。术后Sanders评分和Harris评分优良率分别为86.96%和91.30%。随访病例未出现骨折部位感染、内固定松动断裂、畸形愈合等并发症。结论:有限切开辅助复位技术可很好解决股骨转子下骨折的术中复位问题,钛缆环扎联合髓内钉固定可获得骨折断端良好的对位对线和稳定性,是治疗股骨转子下骨折的有效方法。Objective:To evaluate the surgical technique and clinical effect of less invasive intrame-dullary nail fixation combined with titanium cable cerclage in the treatment of subtrochanteric fractures.Methods:A retrospective study was performed in 46 cases of subtrochanteric fractures in Peking University People’s Hospital from January 2015 to December 2017.Among them,there were 14 males and 32 females,with an average age of(77.83±10.66)years(44-92 years);17 cases on the left side and 29 cases on the right side.The causes of injury included crash from a height,traffic accident and accidental fall.According to Seinsheimer classification,there were 26 cases of typeⅡ,11 cases of typeⅢ,9 cases of typeⅣ,and these cases were all closed injury.After admission,these patients underwent continuous tibial tuberosity bone traction to maintain the length and force line of the lower extremity,so as to reduce the difficulty of intraoperative fracture reduction.Anticoagulant therapy was given before operation to reduce perioperative thrombotic complications.All the patients were treated with less invasive intramedullary nail fixation combined with titanium cable cerclage.Operation time,blood loss during surgery,time of fracture healing were recorded,Harris and Sanders scoring system were used to assess hip function after operation at each follow-up time point.Results:All the included patients underwent surgery successfully.Average operative time and intraoperative blood loss of these patients were(131.09±20.06)min and(191.96±111.03)mL,respectively.All the patients were followed up satisfactorily,with an average follow-up time of 28 months.The fractures received bone healing within 3-6 months,average hospital stay was(10.61±2.85)days.The Sanders score was excellent in 3 cases,good in 37 cases and common in 6 cases,with an excellent and good rate of 86.96%.The Harris score was excellent in 6 cases,good in 36 cases,with an excellent and good rate of 91.30%.There were no cases of wound infection,loss of reduction,nonunion of

关 键 词：有限切开复位 股骨近端髓内钉 股骨转子下骨折 

分 类 号：R683.4[医药卫生—骨科学]