自制钢丝导入器在股骨粗隆下骨折髓内钉术中的应用  

Application of Homemade Steel Wire Introducer in Intramedullary Nailing of Subtrochanteric Fracture of Femur

作　　者：吴天然 陈夏平 王瑞雄 林江游 叶志强 张昭兴 敖庆芳 梁陈佳 王瑞霖 WU Tianran;CHEN Xiaping;WANG Ruixiong;LIN Jiangyou;YE Zhiqiang;ZHANG Zhaoxing;AO Qingfang;LIANG Chenjia;WANG Ruilin(Quanzhou Orthopedic Traumatological Hospital,Fujian Quanzhou 362000,China)

机构地区：[1]福建省泉州市正骨医院,福建泉州362000

出　　处：《中医药临床杂志》2024年第2期355-361,共7页Clinical Journal of Traditional Chinese Medicine

基　　金：2023年泉州市科学技术局医疗卫生领域指导性科技计划项目(自制钢丝导入器在股骨骨折的应用研究,项目编号:2023N029S)资助。

摘　　要：目的:探讨自制钢丝导入器在股骨粗隆下骨折髓内钉术中的应用价值。方法:对2019年1月—2021年12月符合标准的54例需要捆扎协助复位的股骨粗隆下骨折患者相关临床资料进行回顾性分析。术中均应用髓内钉固定,配合自制钢丝导入器经皮进行捆扎协助复位,观察辅助切口的大小、捆扎物导入完成时间、手术时间、术中出血量、骨折复位情况及术后并发症,术后9个月进行髋关节功能Harris评分。结果:辅助切口2.5~3.2cm,中位数2.8cm。捆扎物导入完成时间5~8min,中位数6.5min。手术时间56~90min,中位数72min。术中出血量120~280mL,中位数180mL。所有患者均无切口感染、神经血管损伤等早期并发症。随访时间9~24个月,中位数12个月;所有病例骨折端均获得满意的复位效果;52例如期获得临床愈合,愈合时间11~24周,中位数15周;2例出现骨折延迟愈合,患肢予延长禁止下地负重时间,配合动力化及冲击波治疗,术后10个月骨折愈合;未发现骨感染、骨不连、内固定失效病例等晚期并发症。术后9个月髋关节功能优良率达96.3%。结论:在需要捆扎协助复位的股骨粗隆下骨折髓内钉内固定术中应用自制钢丝导入器进行捆扎固定,其操作简单,辅助切口小,出血少,捆扎物导入成功率高,快速、高效、安全、微创,值得临床参考应用。Objective:To investigate the application value of self-made wire introducer in intramedullary nail operation of subtrochanteric fracture of femur.Methods:From January 2019 to December 2021,the clinical data of 54 patients with subtrochanteric fracture who needed binding and assisted reduction were retrospectively analyzed.There were 28 males and 26 females.The age ranged from 22 to 81years[(55.78±12.25)years].According to Seinsheimer classification,there were 11 cases of IIIA,12 cases of IIIB,21 cases of IVI,and 10 cases of VI.The injury factors included careless fall injury in 15 cases,heavy object injury in 7 cases,traffic injury in 22 cases,and falling injury in 10 cases.The time from injury to operation was 2~7 days[(3.53±1.28)days].The size of the auxiliary incision,completion time of strapping,operation time,intraoperative blood loss,fracture reduction and postoperative complications were observed.The Harris score of hip joint function was performed at 9months after operation.Results:The median incision was 2.8cm(range 2.5~3.2 cm).The completion time of binding import was 5~8 min,with a median of 6.5min.The median operation time was 72min(range 56-90min).The intraoperative blood loss was 120~280 ml,with a median of 180ml.All patients had no early complications such as incision infection and neurovascular injury.The follow-up time was 9~24months,with a median of 12months.Satisfactory reduction results were obtained in all cases.52 cases healing as scheduled,the clinical healing time was 11~24weeks,with a median of 15weeks;Delayed fracture healing occurred in 2 cases,and the affected limb was treated with extended weight-bearing time,combined with dynamic and shock wave therapy,and the fracture healed 10months after operation.No late complications such as bone infection,nonunion and internal fixation failure were found.The Harris score of hip joint function at 9months after operation was excellent in 46 cases,good in 6 cases,and fair in 2 cases.The excellent and good rate was 96.3%.Conclusion:The applicatio

关 键 词：股骨粗隆下骨折 髓内钉 钢丝环扎 

分 类 号：R683[医药卫生—骨科学]