髓内钉联合钢丝捆扎治疗股骨外侧壁不稳定型转子间骨折疗效分析  

Treatment outcomes of proximal femoral compression intramedullary nailing combined with wire binding for intertrochanteric fractures with unstable lateral wall

作　　者：薛超[1] 强廷会[1] 杜兴国[1] 牟欢[1] 郭忠尚 华云[1] 赵家瑞 Xue Chao;Qiang Tinghui;Du Xingguo;Mou Huan;Guo Zhongshang;Hua Yun;Zhao Jiarui(Department of Bone and Joint Surgery,Hanzhong Central Hospital,Hanzhong,Shaanxi Province 723000,China)

机构地区：[1]汉中市中心医院骨关节外科,陕西汉中723000

出　　处：《创伤外科杂志》2024年第6期441-447,共7页Journal of Traumatic Surgery

摘　　要：目的探讨股骨近端联合加压髓内钉联合钢丝捆扎治疗股骨外侧壁不稳定型转子间骨折的手术方法和术后疗效。方法回顾性分析2020年3月—2022年3月汉中市中心医院骨关节外科收治股骨外侧壁不稳定型转子间骨折患者19例,男性8例,女性11例;年龄56~82岁,平均73.1岁。跌倒摔伤17例,道路交通伤2例。采用2018年新版AO/OTA骨折分类,A2以上为股骨外侧壁不稳定型,其中A2.2型4例,A2.3型8例,A3.1型2例,A3.2型1例,A3.3型4例。患者术前均需行双髋关节正位及患髋侧位X线片,必要时行髋关节CT平扫及三维重建。患者均采用股骨近端联合加压髓内钉联合钢丝捆扎内固定手术治疗。统计患者的住院时间、手术时间、出血量、术后开始下床活动时间,分析患者术后3个月的髋关节功能评分、骨折复位及愈合情况、术后并发症情况。结果术后随访6~12个月,平均9.5个月。19例患者住院时间10~23 d,平均15.4 d。手术时间0.75~2 h,平均1.2 h,术中显性出血量100~220 mL,平均160.7 mL。术后开始下床活动时间为7~14 d,平均9.8 d。骨折愈合时间为3~6个月,平均愈合时间4.1个月,无骨折不愈合。术后X线片显示复位好12例,可5例,差2例。术后3个月Harris功能评分68~97分,平均85.4分,其中优12例,良4例,中2例,差1例,优良率为84.2%。术后发生髋内翻2例。结论采用股骨近端联合加压髓内钉结合小切口钢丝捆扎固定治疗股骨外侧壁不稳定型转子间骨折术后疗效满意。Objective To explore the surgical method of proximal femoral compression intramedullary nailing combined with wire binding in the treatment of intertrochanteric fractures with unstable femoral lateral wall and the postoperative effects.Methods A retrospective analysis was performed on 19 patients of intertrochanteric fractures with unstable femoral lateral walls in the Department of Bone and Joint Surgery,Hanzhong Central Hospital between Mar.2020 and Mar.2022.There were 8 males and 11 females aged 56-82(mean 73.1)years,with 17 cases of falls and 2 road traffic injuries.According to the new criteria of AO/OTA fracture classifications in 2018,the unstable femoral lateral wall was defined as those≥A2 types.In this study,there were 4 cases of type A2.2,8 type A2.3,2 type A3.1,1 type A3.2 and 4 type A3.3.Before surgery,all patients underwent normal position radiography of bilateral hips and lateral radiography of the affected hip,or hip CT plain and 3D reconstruction if necessary.All patients were managed by proximal femoral compression intramedullary nailing combined with wire binding.The hospitalization time,operation time,blood bleeding,and postoperative off-bed activity time were recorded.At 3 months after surgery,the hip functional score,fracture reduction and healing,and postoperative complications were analyzed.Results Patients were followed up for 6-12(mean 9.5)months.For all the cases,the hospitalization time was 10-23(mean 15.4)d,operation time 0.75-2(mean 1.2)h,blood loss 100-220(mean 160.7)mL,off-bed activity time 7-14(mean 9.8)d.Fracture healing was achieved in 3-6(mean 4.1)months and no nonunion was found.Postoperative X-ray showed 12 cases of good reduction,5 fair and 2 poor.The Harris hip functional score was 68-97(mean 85.4)at 3 months after surgery,with 12 excellent,4 good,2 fair and 1 poor.The excellent-to-good rate was 84.2%.Two patients developed coxa vara.Conclusion The treatment outcomes of proximal femoral compression intramedullary nailing combined with small-incision wire binding are satis

关 键 词：转子间骨折 加压髓内钉 不稳定型 髋关节 

分 类 号：R687.3[医药卫生—骨科学]