前入路微创钳夹复位技术治疗难复性股骨转子间骨折  

Treatment of irreducible intertrochanteric femoral fracture with minimally invasive clamp reduction technique via anterior approach

作　　者：赵益峰[1] 姜振[1] 李涛 徐重阳[3] 韩亮[1] 褚风龙[1] 吴彬[1] 高明[1] 王海滨[1] ZHAO Yifeng;JIANG Zhen;LI Tao;XU Chongyang;HAN Liang;CHU Fenglong;WU Bin;GAO Ming;WANG Haibin(Department of Traumatic Orthopedics,Affiliated Hospital of Jining Medical University,Jining Shandong,272029,P.R.China;Department of Orthopedics,Wenshang People’s Hospital,Jining Shandong,272501,P.R.China;Department of Imaging,Huaiyin People’s Hospital,Jinan Shandong,250000,P.R.China)

机构地区：[1]济宁医学院附属医院创伤骨科,山东济宁272029 [2]汶上县人民医院骨科,山东济宁272501 [3]济南市槐荫人民医院影像科,济南250000

出　　处：《中国修复重建外科杂志》2021年第5期544-549,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨前入路微创钳夹复位技术治疗难复性股骨转子间骨折的疗效。方法 2015年1月—2019年1月,采用前入路微创钳夹复位技术治疗59例难复性股骨转子间骨折患者。男29例,女30例;年龄45~100岁,平均77.9岁。致伤原因:摔伤46例,交通事故伤6例,砸伤2例,高处坠落伤5例。受伤至手术时间1~14 d,平均3.8 d。骨折AO分型:31-A1型12例,31-A2型25例,31-A3型22例。结果骨折均达良好复位,骨折复位用时10~30 min,平均19 min。患者术后均获随访,随访时间13~25个月,平均17.6个月。其中,2例近骨折段旋前移位者术后内固定失效后,发生感染或坠积性肺炎死亡。6例逆转子骨折者内固定术后外侧壁出现再旋前、外展移位,但骨折均达骨性愈合。其余患者骨折复位未丢失,骨折均达骨性愈合,愈合时间3~9个月,平均5.9个月。除2例死亡患者外,其余57例患者末次随访时髋关节功能Harris评分获优49例、良8例。结论前入路微创钳夹复位技术治疗难复性股骨转子间骨折简便有效、创伤小。对于与外侧壁移位有关的难复性股骨转子间骨折,钳夹复位髓内钉固定后,外侧壁应予以加固,以免复位丢失、内固定失效。Objective To explore the effectiveness of minimally invasive clamp reduction technique via anterior approach in treatment of irreducible intertrochanteric femoral fractures. Methods Between January 2015 and January2019, 59 patients with irreducible intertrochanteric femoral fractures were treated with minimally invasive clamp reduction technique via anterior approach. There were 29 males and 30 females with an average age of 77.9 years(range,45-100 years). The causes of injury included falling in 46 cases, traffic accident in 6 cases, smashing in 2 cases, and falling from height in 5 cases. The time from injury to operation was 1-14 days(mean, 3.8 days). The fractures were classified as AO type 31-A1 in 12 cases, type 31-A2 in 25 cases, type 31-A3 in 22 cases. Results All fractures were reduced well and the fracture reduction took 10 to 30 minutes, with an average of 19 minutes. All patients were followed up 13-25 months,with an average of 17.6 months. Among them, 2 cases of pronation displacement of proximal fracture segment died for infection or falling pneumonia after internal fixation failed. Six patients with reversed intertrochanteric femoral fractures experienced re-pronation and abduction displacement of the lateral wall after internal fixation, but the fractures all healed.The rest of the patients had no fracture reduction loss, and the fractures healed with an average healing time of 5.9 months(range, 3-9 months). Except for 2 patients who died, the Harris score of hip joint function of the remaining 57 patients was excellent in 49 cases and good in 8 cases at last follow-up. Conclusion The minimally invasive clamp reduction technique via anterior approach for irreducible intertrochanteric femoral fractures is simple and effective. For irreducible intertrochanteric femoral fractures related to lateral wall displacement, after clamp reduction and intramedullary nail fixation, the lateral wall should be reinforced in order to avoid reduction loss and internal fixation failure.

关 键 词：难复性股骨转子间骨折 前入路 钳夹复位 微创技术 

分 类 号：R687.3[医药卫生—骨科学]