基于难复与否的股骨转子间骨折分型标准研究  

Research on the classification criteria of femoral intertrochanteric fractures based on irreducibility or not

作　　者：赵益峰[1] 朱凤华[1] 常庆华[2] 刘继恒 张瑞 宋富强[1] 褚风龙[1] 宰庆书 郭伟 杨现伟 石强 张锋 王海滨[1] 姜振[1] ZHAO Yifeng;ZHU Fenghua;CHANG Qinghua;LIU Jiheng;ZHANG Rui;SONG Fuqiang;CHU Fenglong;ZAI Qingshu;GUO Wei;YANG Xianwei;SHI Qiang;ZHANG Feng;WANG Haibin;JIANG Zhen(Department of Traumatic Orthopedics,Affiliated Hospital of Jining Medical University,Jining Shandong,272029,P.R.China;Department of Orthopedics,Jiaxiang People’s Hospital,Jiaxiang Shandong,272400,P.R.China;Department of Orthopedics,Juye Hospital of Chinese Medicine,Juye Shandong,274900,P.R.China;Department of Orthopedics,Wenshang People’s Hospital,Wenshang Shangdong,273500,P.R.China;Department of Traumatic Orthopedics,Yanzhou Hospital Affiliated to Jining Medical University,Jining Shandong,272000,P.R.China;Department of Orthopedics,Yuncheng Tangta Hospital,Yuncheng Shandong,274000,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]嘉祥县人民医院骨科,山东嘉祥272400 [3]巨野县中医院骨科,山东巨野274900 [4]汶上县人民医院骨科,山东汶上273500 [5]济宁医学院附属医院兖州院区创伤骨科,山东济宁272000 [6]郓城唐塔医院骨科,山东郓城274000

出　　处：《中国修复重建外科杂志》2021年第9期1086-1092,共7页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的制定基于难复与否的股骨转子间骨折分型标准,为术前预判股骨转子间骨折复位难易程度提供参考标准。方法回顾性分析2017年1月—2020年3月收治的244例闭合性股骨转子间骨折患者临床资料。男116例,女128例;年龄45~100岁,平均77.9岁。致伤原因:摔伤190例,交通事故伤36例,砸伤13例,高处坠落伤5例。受伤至手术时间1~14 d,平均3.6 d。根据国际内固定研究协会/美国骨创伤协会(AO/OTA)分型标准:31-A1型38例,31-A2型160例,31-A3型46例。根据术中闭合牵引复位是否困难,将患者分为易复位组和难复位组;结合文献以及两组患者术前影像学资料,制定基于难复与否的股骨转子间骨折分型标准。由2名未参加手术的医生根据该分型标准对244例患者骨折进行分型,预判骨折复位难易程度,并与实际术中复位情况进行对比。结果244例患者根据术中骨折复位情况,分为难复位组80例(32.79%)、易复位组164例(67.21%)。比较两组患者影像学资料及特点,制定基于难复与否的股骨转子间骨折分型标准,骨折分为难复性及易复性两大类,难复性分为Ⅰ~Ⅴ型,其中Ⅲ型分为4种亚型;易复性分为Ⅰ、Ⅱ型。与术中实际评价结果比较,医生基于自定的骨折分型标准评定总准确率为81.15%(198/244),其中难复性骨折准确率为65.74%(71/108),易复性骨折为93.38%(127/136)。患者术后均获随访,随访时间13~25个月,平均17.6个月。除2例感染死亡外,其余骨折均愈合。结论基于难复与否的股骨转子间骨折分型标准能在术前准确判断易复性骨折,大部分难复性骨折能以扩大范围的方式做出正确预判,但其临床有效性仍需进一步明确。Objective To formulate the classification criteria of femoral intertrochanteric fractures based on irreducibility or not in order to predict the difficulty of fracture recovery.Methods A clinical data of 244 patients with closed femoral intertrochanteric fractures admitted between January 2017 and March 2020 was retrospectively analyzed.There were 116 males and 128 females with an average age of 77.9 years(range,45-100 years).The cause of injury included falling in 190 cases,traffic accident in 36 cases,smashing in 13 cases,and falling from height in 5 cases.The time from injury to operation was 1-14 days(mean,3.6 days).According to AO/Orthopaedic Trauma Association(AO/OTA)classification,the fractures were classified as type 31-A1 in 38 cases,type 31-A2 in 160 cases,and type 31-A3 in 46 cases.According to whether the recovery difficulty occurred after intraoperative closed traction reset,the patients were divided into reducible-group and irreducible-group;combined with the literature and preoperative imaging data of two groups,the classification criteria of femoral intertrochanteric fractures was formulated based on the irreducibility or not.The 244 fractures were classified by the doctors who did not attend the operation according to the classification criteria,predicted the difficulty of fracture reduction,and compared with the actual intraoperative reduction situation.Results The 244 patients were divided into reducible-group(n=164,67.21%)and irreducible-group(n=80,32.79%)according to the intraoperative difficulty of reduction.Comparing the imaging data and characteristics of the two groups,and formulating the classification criteria of femoral intertrochanteric fractures based on irreducibility or not,the fractures were mainly divided into two categories of irreducibility and reducibility.The fractures of irreducibility category was divided into typesⅠ-Ⅴ,among which typeⅢwas divided into subtypes 1-4;the fractures of reducibility category was divided into typesⅠandⅡ.Compared with the actual intraope

关 键 词：股骨转子间骨折 难复性骨折 分型标准 

分 类 号：R687.3[医药卫生—骨科学]