重新认识尖顶距学说指导股骨转子间骨折治疗的价值  

Re‑understanding the value of the tip‑apex distance theory in guiding treatment of intertrochanteric femoral fracture

作　　者：张殿英[1] Zhang Dianying(Department of Orthopedics and Traumatology,National Center for Trauma Medicine,Key Laboratory of Ministry of Education for Trauma Treatment and Nerve Regeneration,Peking University People′s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院创伤骨科,国家创伤医学中心,创伤救治与神经再生教育部重点实验室,北京100044

出　　处：《中华创伤杂志》2023年第2期121-126,共6页Chinese Journal of Trauma

基　　金：国家重点研发计划(2022YFC3006200);天津市卫生健康委员会科技项目(ZC20049)。

摘　　要：股骨转子间骨折好发于老年骨质疏松患者, 致残、致死率高, 需手术治疗。常用手术方式包括髓内与髓外固定, 但均无法避免术后内固定切出或穿出股骨头等并发症发生。尖顶距学说曾被认为在避免内固定切出中具有重要意义, 其核心观点认为尖顶距≤25 mm时可最大限度避免螺钉切出。但临床工作中符合尖顶距学说的内固定也存在切出和"Z字效应"并发症, 对此临床缺乏合理解释。笔者结合杠杆平衡重建理论和支撑牵张效应, 对尖顶距学说指导股骨转子间骨折治疗的价值进行重新认识, 为提高股骨转子间骨折的治疗效果提供参考。Intertrochanteric femoral fracture occurs frequently in elderly osteoporotic patients,with high disability and mortality,for which surgical treatment is necessary.Common surgical modalities for intertrochanteric femoral fracture include intramedullary and extramedullary internal fixation systems,but neither can avoid the complications like internal fixation cut‑out or internal fixation cut‑through of the femoral head after surgery.The tip‑apex distance theory was once considered to be of great significance in avoiding internal fixation cut‑out,with the mainstream view was that screw cut‑out could be avoided to the maximum extent when the tip‑apex distance was≤25 mm.However,internal fixation that meets the criteria of the tip‑apex distance theory may also show cut‑out and"Z-effect"in clinical practice,which lacks a reasonable explanation.Based on the lever balance reconstruction theory and the buttress‑stretch effect,the author re‑understands the value of the tip‑apex distance theory in guiding treatment of intertrochanteric femoral fracture,hoping to propose an enlightenment for the treatment of intertrochanteric femoral fracture.

关 键 词：股骨骨折 手术后并发症 尖顶距 

分 类 号：R683[医药卫生—骨科学]