Gamma3髓内钉内固定治疗外侧壁危险型股骨粗隆间骨折的疗效观察  

Curative Effect Analysis of Gamma3 Intramedullary Nail for the Treatment of Unstable Femoral Intertrochanteric Fractures with Lateral Wall Risky

作　　者：李成 韩礼纲 王冰心 孙涛 LI Cheng;HAN Li-gang;WANG Bing-xin(Qingdao Central Hospital,Qingdao,266042,China)

机构地区：[1]青岛市中心医院关节与运动医学科,山东青岛266042

出　　处：《医学临床研究》2022年第4期557-560,564,共5页Journal of Clinical Research

摘　　要：【目的】探讨Gamma3髓内钉内固定治疗外侧壁危险型股骨粗隆间骨折的临床疗效。【方法】回顾性分析2018年9月至2021年3月采用Gamma3髓内钉治疗的56例外侧壁危险型股骨粗隆间骨折患者的临床资料。观察术后骨折复位情况、骨折愈合情况、内固定位置、尖顶距(TAD)、股骨矩-尖顶距(CalTAD)、颈干角(NSA)和股骨头颈轴长(FNLA),采用Baumgaertner标准评估骨折端复位质量,Harris髋部评分方法评估患者髋关节功能。【结果】患者骨折愈合时间9~15周,平均11.7周。骨折复位质量:良好27例,可以接受13例,差3例,复位良好率93.0%。NSA122°~147°,平均132°,无髋内翻。TAD平均22.3mm,CalTAD平均23.2mm。Harris评分结果优良率为88.4%。内侧皮质粉碎组患者NSA(124.4±4.8)°明显小于内侧皮质未粉碎组(132.8±5.8)°;FNLA(81.1±4.4)mm明显短于内侧皮质未粉碎组(89.2±5.7)mm,Harris评分(80.8±6.4)分低于内侧皮质未粉碎组(89.8±5.6)分,其差异均有统计学意义(P<0.05)。【结论】Gamma3髓内钉内固定治疗外侧壁危险型股骨粗隆间骨折可取得良好的临床疗效,若合并内侧皮质粉碎可造成骨折内固定稳定性欠佳和降低患者髋关节的功能。【Objective】To explore clinical efficacy for the treatment of unstable femoral intertrochanteric fracture with lateral wall risky by Gamma3 intramedullary nail and analyze the clinical effect of comminuted medial cortex.【Methods】The clinical data of 56 patients with lateral wall risk femoral intertrochanteric fractures treated by Gamma3 intramedullary nail from September 2018 to March 2021were retrospectively analyzed.The quality of fracture reduction,fracture healing,internal fixation position,TAD,CalTAD,the neck shaft angle(NSA)and femoral neck long axis(FNLA)were observed.Baumgaertner criteria were used to evaluate quality of fracture reduction,Harris criteria were used to evaluate hip joint function.【Results】The fracture healing time was 9-15 weeks with average of 11.7 weeks.According to Baumgaertner criteria,27 cases obtained good results,13 cases were acceptable,and 3 poor healing.The good and acceptable rate was 93%.The neck shaft angle was 122°-147°without hip varus(mean,132°).The average of TAD was 22.3mm and the average of CalTAD was 23.2mm.The excellent and good rate of Harris score was 88.4%.In the cases with comminuted medial cortex,the NSA(124.4±4.8)°was significantly less than that in the group without comminuted medial cortex(132.8±5.8)°,P<0.05.The FNLA(81.1±4.4)mm in the comminuted medial cortex group was significantly shorter than that in the group without comminuted medial cortex(89.2±5.7)mm,P<0.05.And its Harris hip score(80.8±6.4)was significantly lower than that in the group without comminuted medial cortex(89.8±5.6,P<0.05).【Conclusion】In the treatment of femoral intertrochanteric fractures with lateral wall risky,Gamma3 intramedullary nail can achieve an excellent clinical outcome.Along with comminuted medial cortex,the presence of lateral wall result in relatively poor stability of internal fixation and decrease hip function.

关 键 词：骨折固定术 髓内/方法 股骨骨折/外科学 骨钉 治疗结果 

分 类 号：R683.421[医药卫生—骨科学]