摘要
目的 探讨微创钢缆辅助加长头颈型髓内钉内固定治疗股骨转子下骨折的手术方法和术后疗效.方法 自2013年1月至2016年2月收治的21例资料完整的股骨转子下骨折患者,男14例,女7例;年龄24～71岁,平均43.5岁.受伤原因包括车祸伤11例,高处坠落伤8例,重物砸伤2例.所有患者采用股骨转子下骨折Seinsheimer分型,其中ⅡB型2例;ⅡC型5例;ⅢA型7例;ⅢB型2例;Ⅳ型1例;Ⅴ型4例.术前行双侧股骨全长CT扫描,测量股骨长度、髓腔直径以及股骨前弓.所有患者均采用微创钢缆辅助加长头颈型髓内钉内固定手术治疗.其中单根钢缆辅助髓内钉固定7例,两根及以上钢缆辅助髓内钉固定14例.结果 术后随访12～36个月,平均22.5个月.其中20例患者术后骨折愈合时间为3～6个月,平均愈合时间4.1个月;1例患者经二次手术骨折愈合,愈合时间距初次手术13个月.根据Harris功能评价标准,术后评分为68～97分,平均85.4分,其中优13例,良6例,可1例,差1例,优良率为90.5％.术后并发症包括拉力螺钉穿出股骨头和骨折不愈合各1例.结论 螺旋形、长斜形及伴有较大蝶形骨块的股骨转子下骨折采取微创钢缆辅助复位加长头颈型髓内钉内固定可以获得满意的术后疗效,但骨折良好愈合的关键在于微创保护骨折块的血供.
Objective To explore the surgical methods and evaluate the postoperative outcomes after cerclage cables and long cephalomedullary nails fixation with minimally invasive technique for the treatment of subtrochanteric femoral fractures.Methods From January 2013 to February 2016,21 patients with subtrochanteric femoral fractures surgically treated were retrospectively analyzed.There were 14 males and 7 females with an average age of 43.5 years old （ranged from 24 to 71 years old）.11 patients suffered by traffic accidents,8 patients fell down from heights and 2 patients injured by collapses of heavy objectives.Subtrochanteric fractures were classified by Seinsheimer classification with 2 cases of type] B,5 cases of type Ⅱ C,7 cases of Ⅲ A,2 cases of Ⅲ B,1 case of Ⅳ and 4 cases of Ⅴ.CT scans of bilateral femurs were performed to measure the length,canal diameter and anterior ache before the operation.All the fractures were treated by cerclage cables and long cephalomedullary nails with minimal invasive technique.7 cases were fixed by one cable and 14 cases by two or more cables.Results All the patients were followed up with an average of 22.5 months （ranged from 12 to 36 months）.The healing time of 20 patients was 3-6 months,with an average time of 4.1 months,except 1 was union by re-operation and the healing time was 13 months after initial operation.According to Harris function evaluation,the average score was 85.4 （ranged from 68 to 97）.The clinical outcomes were rated with excellent in 13 cases,good in 6 cases,fair in 1 case and poor in 1 case.The excellent and good rate was 90.5%.Complications included 1 case of screw cut-out and 1 case of nonunion.Conclusion For the treatment of subtrochanteric fractures with spiral,oblique pattern or a big butterfly fragment,satisfactory outcome could be achieved by fixation of cerclage cables and long cephalomedullary nails.The key to healing is to protect the blood supply of the fracture fragments with minimally invasive technique.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2017年第22期1392-1399,共8页
Chinese Journal of Orthopaedics
关键词
外科手术
微创性
骨折固定术
髓内
髋骨折
Surgical procedures,minimally invasive
Fracture fixation,intramedullary
Hip fractures
