侧卧位髓内钉联合钛缆环扎治疗股骨转子下骨折  

Lateral Decubitus Position Intramedullary Nail Combined With Titanium Cable Cerclage in the Treatment of Femoral Subtrochanteric Fracture

作　　者：翟生[1] 吕青[1] 丁路[1] Zhai Sheng;Lv Qing;Ding Lu(Department of Orthopedics, Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China)

机构地区：[1]新疆医科大学第五附属医院骨一科,乌鲁木齐830011

出　　处：《中国微创外科杂志》2021年第5期454-458,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨侧卧位小切口钛缆环扎辅助复位联合股骨重建髓内钉治疗股骨转子下骨折的临床效果。方法回顾性分析2015年3月~2018年2月19例SeinsheimerⅢ~V型股骨转子下骨折的临床资料,其中ⅢA型9例,ⅢB型6例,Ⅳ型2例,Ⅴ型2例,均为单侧闭合性骨折。侧卧位,小切口钛缆环扎辅助骨折复位,股骨重建髓内钉固定,术后常规抗凝治疗。结果手术时间平均112.3 min(90~210 min),出血量214.3 ml(120~850 ml)。术后12周4例骨折愈合,术后20周均愈合。术后均随访12个月,髋关节功能Harris评分优11例,良6例,可2例,优良率89.5%(17/19)。无下肢深静脉血栓形成、髋内翻畸形、再次骨折、拉力螺钉切割股骨头及断钉等并发症。结论侧卧位行股骨髓内钉固定治疗股骨转子下骨折,利用小切口钛缆环扎辅助骨折复位有利于维持蝶形骨块的复位及髓内钉的准确置入,不影响骨折愈合,是治疗SeinsheimerⅢ~Ⅴ型股骨转子下骨折的可靠的微创内固定方法。Objective To investigate the clinical efficacy and surgical techniques of cable cerclage through a mini-incision approach to assist reduction combined with long femoral reconstruction intramedullary nails for treatment of Seinsheimer typeⅢ-Ⅴsubtrochanteric fractures in the lateral decubitus position.Methods From March 2015 to February 2018,clinical data of 19 cases of Seinsheimer typeⅢ-Ⅴfemoral subtrochanteric fractures were analyzed retrospectively,including 9 cases ofⅢA,6 cases ofⅢB,2 cases ofⅣand 2 cases ofⅤ,all of which were unilateral closed fractures.All the operations were performed in the lateral decubitus position,with cable cerclage assisted reduction and intramedullary nail fixation.All the patients received routine anticoagulant therapy after operation.Results The operative time was 90-210 min(mean,112.3 min);the bleeding volume was 120-850 ml(mean,214.3 ml).Four cases healed at 12 weeks after operation,and all healed at 20 weeks after operation.The patients were followed up for 12 months.The Harris scores of hip joint function at the last follow-up were excellent in 11 cases,good in 6 cases,and fair in 2 cases,yielding an excellent to good rate of 89.5%(17/19).No deep venous thrombosis of lower limb,hip varus deformity,refracture,or cut-out of the femoral head by lag screw or broken screw was observed.Conclusions Lateral decubitus position femoral intramedullary nail fixation in the treatment of subtrochanteric fracture of femur,with the use of small incision titanium cable cerclage to assist fracture reduction,is conducive to maintaining the butterfly shaped bone block reduction and the accurate placement of intramedullary nail.It does not affect the fracture healing,being a reliable minimally invasive internal fixation method for Seinsheimer typeⅢ-Ⅴfemoral subtrochanteric fractures.

关 键 词：股骨转子下骨折 股骨重建钉 环扎 

分 类 号：R687.3[医药卫生—骨科学]