股骨角稳定带锁髓内钉治疗顺转子间骨折的早期疗效  

Femoral stable interlocking intramedullary nail in the treatment of anterograde intertrochanteric fractures

作　　者：杨志强[1] 冯雪峰 王永清[1] 赵志辉[1] 徐占敏 Yang Zhiqiang;Feng Xuefeng;Wang Yongqing;Zhao Zhihui;Xu Zhanmin(Department of Orthopaedics,the Fourth Central Hospital Affiliated to Nankai University,Tianjin 300140,China;Department of Orthopaedics,Second People's Hospital of Hulunbuir City,Hulunbuir 162650,China)

机构地区：[1]南开大学附属第四中心医院骨科,天津300140 [2]呼伦贝尔市第二人民医院骨科,162650

出　　处：《中华骨科杂志》2021年第24期1770-1775,共6页Chinese Journal of Orthopaedics

摘　　要：目的评价股骨角稳定带锁髓内钉(femoral stable interlocking intramedullary nail,FSIIN)治疗顺转子间骨折的疗效。方法回顾性分析2005年1月至2019年2月采用FSIIN治疗并获得随访的顺转子间骨折患者36例,其中29例来自南开大学附属第四中心医院、7例来自呼伦贝尔市第二人民医院。根据远端是否安装锁钉固定分为锁定组和不锁定组。锁定组15例,男6例,女9例;年龄(68.53±10.82)岁(范围48~80岁);AO/OTA分型,31-A1型7例,31-A2型8例。不锁定组21例,男12例,女9例;年龄(67.86±11.70)岁(范围46~85岁);AO/OTA分型,31-A1型9例,31-A2型12例。比较两种固定方式的手术时间、术中出血量、骨折愈合时间,末次随访时采用视觉模拟评分(visual analogue scale,VAS)和Harris评分评价术后疗效。结果两组均获得随访,锁定组随访时间(16.73±3.41)个月(范围10~24个月),不锁定组(16.10±3.36)个月(范围10~24个月)。锁定组手术时间(43.47±2.39)min、术中出血量(149.33±44.96)ml、骨折愈合时间(14.57±1.50)周,不锁定组分别为(33.29±5.30)min、(97.62±38.46)ml、(10.16±1.20)周,两组差异均有统计学意义(t=6.930、3.708、9.818,均P<0.001)。末次随访时,锁定组VAS评分为(1.60±0.63)分,不锁定组为(1.81±1.08)分,两组比较差异无统计学意义(t=0.673,P=0.506);锁定组Harris评分为(84.33±2.53)分,不锁定组为(84.90±2.19)分,两组比较差异无统计学意义(t=0.724,P=0.474)。术后8周,1例患者出现近端下位锁钉退出1 cm,未做处理,术后16周骨折愈合。结论FSIIN远端锁定与不锁定均为治疗股骨顺转子间骨折有效治疗方法;相对于远端锁定固定,远端不锁定具有手术操作更简单、创伤小及骨折愈合更快的优势。Objective:To evaluate the efficacy of femoral stable interlocking intramedullary nail(FSIIN)in the treatment of anterograde intertrochanteric fractures.Methods:FSIIN was invented to treat femoral intertrochanteric fractures.From January 2005 to February 2019,36 cases of anterograde intertrochanteric fractures were retrospectively analyzed.Among them,29 cases were from the Fourth Central Hospital Affiliated to Nankai University and 7 cases were from the Second People's Hospital of Hulunbuir City.15 cases(6 males and 9 females)were treated with FSIIN distal locking fixation(distal locking group).The average age was 68.53±10.82 years(range,48-80 years old);According to AO/OTA classification,there were 7 cases of 31-A1 type and 8 cases of 31-A2 type.21 cases(12 males and 9 females)were treated by FSIIN distal fixation non-locking(distal unlocking group).The average age was 67.86±11.70 years(range,46-85 years).there were 9 cases of 31-A1 type and 12 cases of 31-A2 type.The operation time,intraoperative blood loss,fracture healing time,visual analogue scale(VAS)and Harris scores at the last follow-up were compared between the two fixation methods.Results:Both groups were followed up for 10-24 months,and the mean time in the lock group was 16.73±3.41 months.The mean time in the non-locking group was 16.10±3.36 months.In the locked group,the operation time was 43.47±2.39 min,the intraoperative blood loss was 149.33±44.96 ml,and the fracture healing time was 14.57±1.50 weeks.In the non-locking group,the operation time was 33.29±5.30 min,intraoperative blood loss was 97.62±38.46 ml,and fracture healing time was 10.16±1.20 weeks.The operation time of the non-locking group was shorter than the locking group(t=6.930,P<0.001),intraoperative blood loss was decreased than the locking group(t=3.708,P<0.001),fracture healing time was reduced than the locking group(t=9.818,P<0.001).At the last follow-up,the VAS score of the locked group was 1.60±0.63 and the non-locked group was 1.81±1.08,which showed no significant dif

关 键 词：股骨骨折 骨折固定术 髓内 内固定器 

分 类 号：R687.3[医药卫生—骨科学]