全角度复位固定难复性股骨粗隆间骨折  

Circumferential reduction for irreducible intertrochanteric fractures of the femur

作　　者：孙春光[1] 李成[1] 韩沐 魏桐 王友华[2] SUN Chun-guang;LI Cheng;HAN Mu;WEI Tong;WANG You-hua(Department of Orthopedics,People's Hospital of Funing County,Funing 224400,Jiangsu,China;Department of Orthopedics,Affiliated Hospital,Nantong University,Nantong 226001,Jiangsu,China)

机构地区：[1]阜宁县人民医院骨科,江苏阜宁224400 [2]南通大学附属医院骨科,江苏南通226001

出　　处：《中国矫形外科杂志》2025年第7期653-656,共4页Orthopedic Journal of China

基　　金：盐城市基础研究计划项目(编号:YCBK2023099)。

摘　　要：[目的]探讨全角度复位固定治疗小粗隆二分型难复性股骨粗隆间骨折(irreducible intertrochanteric fractures of the femur,IRIFF)的临床疗效。[方法]2020年1月—2022年12月18例小粗隆二分型IRIFF患者,采用冠状位钳夹联合矢状位撬拨全角度辅助复位髓内钉内固定治疗。评价临床及影像结果。[结果]本组患者手术时间(39.7±7.0)min,术中出血量(124.7±50.0)mL。患者均获(11.7±2.1)个月随访。1例因头钉切割行半髋关节置换。随术前,术后4周和末次随访的时间推移,VAS评分[(6.4±1.1),(2.8±1.5),(0.7±1.1),P<0.001]、髋关节Harris评分[(37.9±8.3),(71.6±10.8),(92.7±10.3),P<0.001]、髋伸屈ROM[(5.3±4.4)°,(67.4±13.0)°,(97.2±13.0)°,P<0.001]均显著改善。影像方面,与术前相比,术后4个月及末次随访时,患髋关节颈干角[(76.5±8.2)°,(129.1±4.9)°,(125.1±7.0)°,P<0.001]显著增大,与术后4周相比,末次随访时,尖顶距无显著变化(P>0.05),17例患者骨折一期愈合,骨折愈合时间为(6.6±1.5)个月。[结论]全角度辅助复位技术内固定治疗小粗隆二分型IRIFF,复位固定满意,临床疗效确切。[Objective]To explore the effectiveness of circumferential reduction technique in treatment of irreducible intertrochanteric fractures of the femur(IRIFF)with lesser trochanter bisection fractures.[Methods]Between January 2020 and December 2022,18 patients received circumferential reduction and proximal femoral nail fixation for IRIFF with lesser trochanter bisection fracture.The operative duration,blood loss,reduction quality,VAS score and Harris score at 4-week postoperatively and the latest follow-up were recorded and evaluated.[Results]All patients in this group had operation performed successfully with the operative time of(39.7±7.0)min,and the intraoperative blood loss of(124.7±50.0)mL.All patients were followed up for(11.7±2.1)months,one of them underwent revision surgery of hip hemiarthro-plasty due to implant loosening.With time preoperatively,4 weeks postoperatively and at the latest followup,the VAS score[(6.4±1.1),(2.8±1.5),(0.7±1.1),P<0.001],Harris score[(37.9±8.3),(71.6±10.8),(92.7±10.3),P 0.001],hip flexion-extension ROM[(5.3±4.4)°,(67.4±13.0)°,(97.2±13.0)°,P 0.001]were significantly improved.Radiographically,the femoral neck-shaft angle of the affected hip[(76.5±8.2)°,(129.1±4.9)°,(125.1±7.0)°,P 0.001]was significantly increased at 4 months after surgery and the last follow-up compared with those preoperatively.However,the tip-apex distance of the implant remained unchanged at the latest follow-up compared with that 4 weeks after operation(P>0.05).Of them,17 patients got primary fracture healing with the healing time of(6.6±1.5)months.[Conclusion]The circumferential reduction technique does effectively reduce irreducible intertrochanteric fracture of the femurfor proximal femoral nail fixation,and achieves satisfactory clinical outcome.

关 键 词：难复性股骨粗隆间骨折 小粗隆骨折 全角度辅助复位 

分 类 号：R683.42[医药卫生—骨科学]