小切口复位临时固定辅助股骨近端防旋髓内钉治疗股骨转子间骨折  

Small incision reduction and temporary fixation assisted proximal femoral nail anti-rotation on femoral intertrochanteric fracture

作　　者：王浩然 张文杰 郑宏瑞 何斌[1] 王云华[1] 范磊[1] WANG Hao-ran;ZHANG Wen-jie;ZHENG Hong-rui;HE Bin;WANG Yun-hua;FAN Lei(Dept of Orthopaedics,the Second Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210011,China)

机构地区：[1]南京医科大学第二附属医院骨科,江苏南京210011

出　　处：《临床骨科杂志》2024年第1期83-86,共4页Journal of Clinical Orthopaedics

基　　金：江苏省卫建委2020年度医学科研立项面上项目(编号:M2020059);江苏省卫健委老年健康科研面上项目(编号:LKM2022007)。

摘　　要：目的探讨小切口复位临时固定辅助股骨近端防旋髓内钉(PFNA)治疗股骨转子间骨折的疗效。方法采用小切口复位临时固定辅助PFNA治疗28例股骨转子间骨折患者。记录术中出血量、手术时间、骨折复位质量、骨折愈合情况。采用Harris评分评价髋关节功能。结果患者均获得6个月随访。术后无切口感染情况发生。术中出血量95~110(100.5±8.0)ml,手术时间45~57(50.5±4.5)min。骨折复位质量:解剖复位20例,功能复位5例,复位不良3例。术后3个月Harris评分67~95(88.32±8.07)分,其中优20例、良5例、差3例,优良率25/28。26例骨折愈合,时间3~4个月,其中1例术后髋内翻畸形,无螺钉松动,应患者要求未做特殊处理;1例术后螺旋刀片向外侧切出、1例术后骨折不愈合,考虑二次行翻修手术治疗。结论小切口复位临时固定辅助PFNA治疗股骨转子间骨折,手术操作简单,创伤小,不影响PFNA操作,可辅助增强牵引床的牵引作用,疗效满意。Objective To investigate the effect of proximal femoral nail anti-rotation(PFNA)assisted with temporary fixation for treatment of femoral intertrochanteric via small incision reduction.Methods The 28 cases of femoral intertrochanteric fractures were treated by small incision reduction and temporary fixation assisted PFNA.The intraoperative blood loss,operation time,fracture reduction quality and fracture healing were recorded.Harris score was used to evaluate hip function.Results All patients were followed up for 6 months.There was no occurrence of incision infection after surgery.The intraoperative bleeding volume was 95~110(100.5±8.0)ml,and the surgical time was 45~57(50.5±4.5)min.Quality of fracture reduction:anatomical reduction was in 20 cases,functional reduction was in 5 cases,and poor reduction in 3 cases.Three months after surgery,the Harris scores were 67~95(88.32±8.07)points,of which 20 cases were excellent,5 cases were good,and 3 cases poor,the excellent-good rate was 25/28.All 26 cases of fractures healed in 3~4 months,including 1 case with postoperative hip varus deformity and no screw loosening,and no special treatment was performed at the patient′s request.After surgery,the spiral blade was cut out in 1 case,and 1 case had nonunion,the secondary revision surgeries were considered for treatment.Conclusions Small incision reduction and temporary fixation assisted PFNA are used to treat femoral intertrochanteric fracture,which are simple operation,less trauma,and do not affect the PFNA operation,and can help to increase the holding role of the traction bed,with satisfactory efficacy.

关 键 词：股骨转子间骨折 内固定 顶棒 克氏针 复位钳 股骨近端防旋髓内钉 

分 类 号：R683.42[医药卫生—骨科学] R687.32[医药卫生—外科学]