颈基底型股骨转子间骨折楔效应的影像学研究及治疗分析  

Radiological and therapeutic study of the wedge effect of basicervical femoral trochanter fractures

作　　者：张宇[1] 黄嘉琛 章海军 钱考亮 胡军[1] Zhang Yu;Huang Jiachen;Zhang Haijun;Qian Kaoliang;Hu Jun(Department of Orthopedics,the First Affil-iated Hospital of NJMU,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院骨科,210029

出　　处：《中华老年骨科与康复电子杂志》2021年第5期271-276,共6页Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)

基　　金：国家自然科学基金(81672218)。

摘　　要：目的探讨股骨近端防旋髓内钉(PFNA)治疗颈基底型股骨转子间骨折时楔效应的影像学特点及处理措施。方法回顾性分析了我院2013年至2018年手术治疗的386例股骨转子间骨折病例,选取采用PFNA治疗的颈基底型股骨转子间骨折病例。依据术后髋关节影像学资料,统计出现楔效应的发生率,测量患者双侧颈干角和股骨头中心到股骨外侧皮质的距离。该组病例中出现楔效应的患髋作为试验组,健髋作为自身对照组,分析楔效应组骨折影像学特点和对PFNA固定复位质量的影响。结果共有39例PFNA治疗的颈基底型股骨转子间骨折病例,男13例,女26例,平均年龄(72±5)岁。其中有21例术后出现楔效应而纳入研究,男10例,女11例,平均年龄(74±6)岁。术后影像测量发现,楔效应组股骨颈干角平均为(129.4±3.7)°,小于自身对照组(P<0.05);楔效应组股骨头到股骨外侧皮质距离平均为(63.2±6.8)mm,高于自身对照组(P<0.05);楔效应组后外侧骨折块的解剖影像学特点可分为4个亚型。术后随访发现,楔效应组患者治疗1年后的Harris评分明显低于未发生楔效应的PFNA治疗的颈基底型股骨转子间骨折组(P<0.05)。结论揭示了PFNA治疗颈基底型股骨转子间骨折时存在的楔效应的影像学特点及形成原因,正确认识楔效应有助于提高髓内固定转子间骨折的复位质量,减少内置物相关并发症。Objective To investigate the imaging characteristics and treatment of the wedge effect of basicervical intertrochanteric fracture with proximal femoral nail anti-rotation(PFNA).Methods In this study,386 cases of intertrochanteric fracture treated by surgery from 2013 to 2018 were analyzed retrospec-tively,including 39 cases of basicervical intertrochanteric fracture treated by PFNA.According to the imag-ing data of the hip joint after surgery,the wedge effect was seen in some cases.Distances from the bilateral neck-shaft angle and the femoral head to the lateral femoral cortex were measured,respectively.The affected side was treated as the wedge effect group and the healthy side was seen as the control group.Then the imag-ing characteristics of fractures in the wedge effect group and the efficacy of PFNA were analyzed.Results There were 39 cases(13 males and 26 females)of basicervical intertrochanteric fracture treated with PFNA,with an average age of(72±5).The wedge effect was found in 21 cases,including 10 males and 11 females,with an average age of(74±6).The average femoral neck-shaft angle in the wedge effect group was(129.4±3.7)°,which was significantly smaller than that in the control group(P<0.05).The average distance from the femoral head to the lateral cortex in the wedge effect group was(63.2±6.8)mm,which was also significantly longer than that in the control group(P<0.05).The features of radiographic anatomy for posterior-lateral frac-tures in the wedge effect group can be divided into 4 subtypes.One year after surgery,the Harris Hip Score in the wedge effect group was significantly less than that in the PFNA group without wedge effect(P<0.05).Conclusion The imaging characteristics and the cause of wedge effect in the treatment of basicervical inter-trochanteric fracture with PFNA are identified.Developed a better understanding of the wedge effect,that will help to improve the restoration of intertrochanteric fractures with intramedullary fixation and reduce the complications associated with impla

关 键 词：髓内钉 内固定 髋骨折 

分 类 号：R687.3[医药卫生—骨科学]