难复性股骨转子间骨折的新分型与复位策略研究  

Strategies for reduction of irreducible intertrochanteric fractures according to self-designed new classifications

作　　者：李翔[1] 王爱国[1] 时晓华 马富强[1] 吕岩 赵士君[1] 张威[1] 史炎鑫 Li Xiang;Wang Aiguo;Shi Xiaohua;Ma Fuqiang;Lyu Yan;Zhao Shijun;Zhang Wei;Shi Yanxin(Department of Minimally Invasive Orthopaedics,Zhengzhou Orthopaedics Hospital,Zhengzhou 450052,China)

机构地区：[1]郑州市骨科医院微创骨科,郑州450052

出　　处：《中华创伤骨科杂志》2023年第9期762-769,共8页Chinese Journal of Orthopaedic Trauma

基　　金：河南省科技攻关项目(222102310718)。

摘　　要：目的探讨难复性股骨转子间骨折的新分型,以及在新分型指导下的复位策略及临床疗效。方法回顾性分析2019年1月至2021年12月期间郑州市骨科医院收治的124例难复性股骨转子间骨折患者资料。男56例,女68例;年龄(76.8±13.2)岁。根据骨折近端头颈骨块的移位方式,将难复性股骨转子间骨折分为3型:1型(旋转型)65例,根据小转子位置再分为3个亚型:1.1型(小转子连在骨折远端型)24例,1.2型(小转子连在骨折近端型)8例,1.3型(小转子游离型)33例;2型(绞锁型)18例,也分为3个亚型:2.1型(小转子游离型)13例,2.2型(小转子连在骨折近端型)0例,2.3型(小转子连在骨折远端型)5例;3型(反转子型)41例。在新的分型指导下,对患者采用相应技巧(应用撬拨、钳夹、提拉及克氏针临时固定等技术)复位后行髓内钉固定。记录患者的手术时间、术中出血量、骨折复位质量及末次随访时髋关节Harris评分等。结果本组患者的手术时间为(53.0±20.7)min,术中出血量为(132.1±81.3)mL。根据Chang等、Kim等标准评定术后骨折复位质量:优101例,良17例,可4例,差2例,优良率为95.2%(118/124)。124例患者术后获(12.4±3.7)个月随访。120例患者骨折一期愈合,2例3型患者主钉断裂后更换髓内钉后愈合,此122例患者的骨折愈合时间为(5.1±1.4)个月;另有2例1.3型患者头钉切割股骨头行半髋关节置换术。5例患者术后出现泌尿系统感染,经对症治疗后痊愈。末次随访时髋关节Harris评分为(94.2±5.4)分;优103例,良17例,差4例,优良率为96.8%(120/124)。结论基于骨折近端头颈骨块移位方式划分的难复性股骨转子间骨折新分型,能直接、有效地指导术中复位,并可获得满意的复位与固定效果,且易于理解和掌握。Objective To explore the strategies for reduction of irreducible intertrochanteric fractures according to our self-designed new classifications.Methods A retrospectively study was conducted to analyze the data of 124 patients with irreducible intertrochanteric fracture who had been admitted to Department of Minimally Invasive Orthopaedics,Zhengzhou Orthopaedics Hospital from January 2019 to December 2021.There were 56 males and 68 females with a mean age of(76.8±13.2)years.According to the displacement pattern of the proximal head-neck fragment of the fracture,the irreducible intertrochanteric fractures of the femur were classified into 3 types.In type 1(rotational type)of 65 cases,there were 24 cases of subtype 1.1(the lesser trochanter attached to the distal fracture fragment),8 cases of subtype 1.2(the lesser trochanter attached to the proximal fracture fragment),and 33 cases of subtype 1.3(the lesser trochanter floating).In type 2(locked type)of 18 cases,there were 13 cases of subtype 2.1(lesser trochanter floating),no case of subtype 2.2(the lesser trochanter attached to the proximal fracture fragment),and 5 cases of subtype 2.3(the lesser trochanter attached to the distal fracture fragment).In type 3(reverse trochanter type)there were 41 cases.Under the guidance of our new classification,the patients were treated by fixation with intramedullary nails after reduction with corresponding techniques(like prying,clamping,pulling,and temporary fixation with Kirschner wires).Operation time,intraoperative blood loss,fracture reduction quality and Harris hip score at the last follow-up were recorded.Results The operation time was(53.0±20.7)min and blood loss(132.1±81.3)mL in this cohort.According to the criteria proposed by Chang and Kim et al.,the quality of fracture reduction was evaluated as excellent in 101 cases,as good in 17 cases,as fair in 4 cases,and as poor in 2 cases,resulting in an excellent and good rate of 95.2%(118/124).All the 124 patients were followed up for an average of(12.4±3.7)months.First-

关 键 词：髋骨折 骨折固定术 髓内 难复 分型 复位技巧 

分 类 号：R687.3[医药卫生—骨科学]