股骨转子间骨折后壁冠状面“香蕉样骨块”特点及其在头髓钉治疗中的研究进展  

Characteristics of posterior coronal banana-shaped fragments and its research progress in treatment of intertrochanteric femoral fracture with cephalomedullary nail

作　　者：李浩涛 李力文 张世民 LI Haotao;LI Liwen;CHANG Shimin(Department of Orthopedics,Yangpu Hospital,Tongji University,Shanghai,200090,P.R.China)

机构地区：[1]同济大学附属杨浦医院骨科,上海200090

出　　处：《中国修复重建外科杂志》2024年第12期1517-1523,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(81772323);上海市自然科学基金资助项目(23ZR1459300)。

摘　　要：目的总结股骨转子间骨折后壁冠状面“香蕉样骨块”特点及其在头髓钉治疗中的研究进展,为临床提供参考。方法广泛查阅国内外相关文献,从后壁冠状面香蕉样骨块的认识历史、解剖结构、是否需要复位内固定、对头髓钉稳定性的影响以及弥补措施等方面进行总结。结果后壁冠状面香蕉样骨块是指转子间骨折的第二级骨折线同时累及了转子间后壁的4个解剖结构,即大转子后部、转子间嵴、小转子和后内侧皮质。3DCT扫描在临床上的广泛应用使得后壁冠状面香蕉样骨块得到更为全面的认识。按照骨折线向前扩展是否影响头颈内植物在外侧壁入口的完整性,后壁冠状面香蕉样骨块可分为小型和大型两种,其中大型单一香蕉样骨块约占国际内固定研究协会/美国骨创伤协会(AO/OTA)A2型骨折的20%。大型骨块如果向内累及后内侧壁(小转子),则增加了内侧皮质对位砥住的难度;如果向外累及后外侧壁,导致外侧壁皮质入口通道破裂(A2.4型),则会引发头髓钉在股骨髓腔内的矢状面摆动,从而影响头髓钉稳定性。目前对于后壁冠状面香蕉样骨块尚无良好技术进行复位和内固定。通过提高前内侧皮质的复位质量、选用充盈度高的头髓钉等方法,可弥补后壁冠状面香蕉样骨块导致髓内钉摆动的不利影响。结论后壁冠状面香蕉样骨块容易导致头颈内植物入口通道破裂,引起头髓钉矢状面摆动继而导致骨折复位丢失,影响治疗效果。是否发生外侧壁入口破裂及其危险因素尚需进一步临床和基础研究明确。Objective To summarize the characteristics of posterior coronal banana-shaped fragments and its research progress in treatment of intertrochanteric femoral fracture with cephalomedullary nail,provide valuable reference for clinical practice.Methods Relevant domestic and foreign literature was extensively reviewed to summarize the history,anatomical structure of posterior coronal banana-shaped fragments,and the need for reduction and fixation,the influence on the stability of cephalomedullary nail,and the remedies.Results The posterior coronal banana-shaped fragments refers to the second level fracture line of the intertrochanteric femoral fracture,involving four anatomical structures,namely,the posterior part of the greater trochanter,the intertrochanteric crest,the lesser trochanter,and the posteromedial cortex.With the wide application of three-dimensional-CT in clinical practice,the posterior coronal banana-shaped fragments were more comprehensively understood.According to whether the anterior extension of the fracture line affects the integrity of the lateral entry of the head and neck implant,the posterior coronal banana-shaped fragments can be divided into small and large ones,of which the large single banana-shaped fragment account for about 20%of the AO/Orthopaedic Trauma Association(AO/OTA)type A2 fractures.If the large fragment involving the posteromedial wall(lesser trochanter)will increase the difficulty of the medial cortical contact reduction;or involving the posterolateral wall and resulting in rupture of the entry portal(type A2.4),which will cause sagittal swing of the nail in the femoral marrow cavity,thereby affecting the stability of the nail.There is no effective technique for reduction and fixation of the banana-shaped fragment nowadays.However,the adverse effects of posterior coronal banana-shaped fragment can be compensated by improving the quality of fracture reduction and choosing high filling cephalomedullary nail.Conclusion The posterior coronal banana-shaped fragments can easily lead

关 键 词：股骨转子间骨折 头髓钉 冠状面骨折线 香蕉样骨块 髓内钉摆动 前内侧皮质 

分 类 号：R687.3[医药卫生—骨科学]