小切口股骨扩髓防旋髓内钉固定治疗股骨转子间骨折  

Femoral intertrochanteric fracture treated by proximal femoral nail anti-rotation using reaming femoral cavity with small incision

作　　者：肖奕增 王清铿 黄东海 尤瑞金 赵枫[1] XIAO Yi-zeng;WANG Qing-keng;HUANG Dong-hai;YOU Rui-jin;ZHAO Feng(Dept of Orthopaedics,the 910th Hospital of Logistic Support Force of CPLA,Quanzhou,Fujian 362000,China)

机构地区：[1]中国人民解放军联勤保障部队第九一○医院骨科,福建泉州362000

出　　处：《临床骨科杂志》2023年第3期404-407,共4页Journal of Clinical Orthopaedics

摘　　要：目的探讨无牵引床情况下采用小切口感触辅助复位结合阶梯开口扩髓技术行股骨近端防旋髓内钉(PFNA)固定治疗股骨转子间骨折的疗效。方法在无牵引床的情况下采用小切口感触辅助复位结合阶梯开口扩髓技术行PFNA固定治疗48例股骨转子间骨折患者。记录手术时间、术后骨折端前内侧皮质抵住支撑情况、骨折愈合时间及并发症发生情况,末次随访时采用Harris评分评价髋关节功能。结果患者均获得随访,时间6~18个月。手术时间22~41(31.5±4.9)min。术后骨折端前内侧皮质抵住支撑率100%。骨折愈合时间9~16周。未出现切口感染、骨折不愈合、骨折畸形愈合、内固定松动断裂、螺旋刀片切出等并发症。末次随访时采用Harris评分评价髋关节功能:优28例,良17例,可3例,优良率93.8%。结论在无牵引床的情况下采用小切口感触辅助复位结合阶梯开口扩髓技术行PFNA固定治疗股骨转子间骨折,操作简单,手术时间短,骨折愈合率高,并发症少,关节功能恢复好。Objective To investigate the efficacy of femoral intertrochanteric fracture treated by proximal femoral nail anti-rotation(PFNA)without traction bed,using sensation-assisted reduction via small incision combined with serial opening and reaming femoral cavity technique.Methods Forty-eight patients who suffered from femoral intertrochanteric fractures were treated by PFNA without traction bed,using sensation-assisted reduction via small incision combined with serial opening and reaming femoral cavity technique.The operation time,postopertive anterior-medial cortical resist-support condition of fracture end,fracture healing time,complication were recorded.Hip function was evaluated by Harris score system at last follow-up.Results All patients were followed up from 6 months to 18 months.Operation time was 22~41(31.5±4.9)min,the resist-support rate of anterior-medial cortical of fracture end was 100%postoperatively,fracture healing time was 9~16 weeks.No operation-related complications such as incision infection,ununion,malunion,internal fixation loosening or breakage,spiral blade cutting out occurred.Harris score of hip function at last follow up:28 cases were excellent,17 cases good,3 fair,with an excellent-good rate of 93.8%.Conclusions For the treatment of femoral intertrochanteric fracture with PFNA without traction bed,the application of sensation-assisted reduction by small incision combine with serial opening and reaming femoral cavity technique is convenient,shorter operation time,higher healing rate,fewer complication and better hip function recovery.

关 键 词：股骨转子间骨折 小切口 感触辅助复位 阶梯开口扩髓技术 股骨近端防旋髓内钉 牵引床 

分 类 号：R683.42[医药卫生—骨科学] R687.33[医药卫生—外科学]