内侧皮质支撑在InterTan内固定治疗股骨转子间骨折中的应用研究  

Fracture Reduction with Different Medial Cortical Support in Pertrochanteric Fractures Treated with Intertan Fixation

作　　者：张兴胜 桑庆华 张晓光 杨飞 胡黎婷 李东亮 Zhang Xingsheng;Sang Qinghua;Zhang Xiaoguang;Yang Fei;Hu Liting;Li Dongliang(Department of Orthopaedics,Yanqing Hospital of Peking University Third Hospital,Beijing 102100,China)

机构地区：[1]北京大学第三医院延庆医院骨科,首都医科大学延庆教学医院骨科,北京102100

出　　处：《实用骨科杂志》2023年第6期487-490,508,共5页Journal of Practical Orthopaedics

基　　金：北京市延庆区2021年度优秀人才培养专项经费资助管理项目(YQRC2021-0208)。

摘　　要：目的分析股骨转子间骨折InterTan髓内钉内固定术后,内侧皮质不同支撑复位方式对患者影像学及临床功能的影响。方法收集北京市延庆区医院2017年1月至2020年12月使用InterTan髓内钉内固定治疗老年股骨转子间骨折133例患者资料,男61例,女72例;年龄61~87岁,平均(77.2±6.4)岁。根据术后头颈骨块内侧骨皮质与股骨干内侧骨皮质的解剖对位关系,分为三组。正性支撑组(A组)30例,中性支撑组(B组)77例,负性支撑组(C组)26例。比较三组患者术前一般资料,术后股骨颈干角、股骨颈长度变化及髋关节功能评分。结果133例患者随访3~24个月,平均随访(12.1±8.9)个月。C组2例患者术后发生螺钉切割,行全髋关节置换术翻修,其余患者转子间骨折均获得骨性愈合。末次随访,A、B、C三组患者颈干角分别丢失(2.10±1.61)°、(1.73±2.02)°、(5.60±5.61)°,股骨颈长度分别丢失(2.16±1.30)mm、(1.92±1.16)mm、(5.62±4.22)mm。C组颈干角及股骨颈长度丢失程度最大,与A组及B组比较,差异有统计学意义(P<0.05)。采用改进的D’Aubigné-Postel评分,术后1个月A、B、C组髋关节功能优良率分别为73.3%、76.6%、50.0%,A、B组患者早期较C组患者获得更好的功能,差异有统计学意义(P<0.05);末次随访,三组患者优良率分别为93.3%、97.4%、92.3%,组间比较差异均无统计学意义(P>0.05)。结论内侧皮质正性及中性支撑复位在股骨转子间骨折InterTan髓内钉术后,患者颈干角及股骨颈长度丢失少,早期可取得更好的临床效果。在手术复位过程中,尽量避免负性支撑复位,降低螺钉切割等并发症发生率。Objective To analyze the effects of different medial cortical support reduction on the results of radiological and clinical function in pertrochanteric fractures treated with InterTan fixation.Methods A total of 133 cases,including 61 men and 72 women,with average age(77.2±6.4)years of pertrochanteric fractures at Yanqing Hospital of Peking University Third Hospital were treated with InterTan from January 2017 to December 2020.They were divided into three groups according to the relationship of the medial cortex between the femoral shaft and the medial femoral neck after operation,positive support(group A,30 cases),neutral support(group B,77 cases)and negative support(group C,26 cases).The patient demographic of the three groups were compared.The variations of neck-shaft angle and femoral neck length and functional scores after operation were also compared statistically.Results 133 patients were followed up for 3 to 24 months,with a mean follow-up of(12.1±8.9)months.In group C,two patients occurred cut-out,and underwent total hip arthroplasty revision.The rest of the patients had bony healing of the intertrochanteric fracture.At the final follow-up,the loss of neck stem angle was(2.10±1.61)°,(1.73±2.02)°,(5.60±5.61)°in groups A、B and C,respectively.And the loss of femoral neck length was(2.16±1.30)mm,(1.92±1.16)mm,(5.62±4.22)mm respectively.Group C showed the greatest loss of cervical stem angle and femoral neck length,with statistically significant differences compared with groups A and B(P<0.05).After 1 months of follow-up,the functional recovery scores in group A and group B showed good functional outcomes than group C(P<0.05),while the basic activities of daily living were all recovered after at the final follow-up.There was no statistical difference among the three groups(P>0.05).Conclusion Positive and neutral support reduction of medial cortex combined with InterTan fixation resulted in the least loss of neck stem angle and femoral neck length in patients and can achieve better clinical result

关 键 词：股骨转子间骨折 INTERTAN 正性支撑 内侧皮质 

分 类 号：R683.42[医药卫生—骨科学]