摘要
目的探讨枪式复位钳辅助复位和股骨近端防旋髓内钉(PFNA)内固定治疗内外向难复性股骨转子间骨折的初步疗效,评估该技术的复位效果和对骨折愈合的影响。方法选择浙江大学丽水医院(丽水市中心医院)2012年1月至2016年12月收治的内外向不稳、难复性股骨转子间骨折患者21例为研究对象,其中男12例,女9例;年龄范围51~91岁,平均76.7岁;均为新鲜闭合性不稳定性骨折;根据国际内固定研究协会(AO/ASIF)分型:3.1-A1型6例,3.1-A2型11例,3.1-A3型4例。采用抢式复位钳辅助复位和股骨近端防旋髓内钉内固定治疗,对其围手术期及短期随访的疗效、功能恢复情况等进行分析。结果手术平均时间为61.7 min(40~110 min),出血量平均为131.7 mL(45~450 mL),住院平均时间为13.6 d(7~29 d)。围术期无严重并发症或原有合并症加重。获得随访时间10~18个月,平均13.3个月,末次随访时所有股骨转子间骨折均愈合,愈合时间平均为13.2周(10~17周)。无内固定物失效、螺旋刀片切割股骨头、髋内翻畸形及再发骨折等发生。末次随访时按Harris髋关节功能评分,优6例,良13例,可2例,优良率90.5%。结论对内外向难复性股骨转子间骨折,采用枪式复位钳辅助复位和PFNA内固定治疗,可获得满意的复位和较好的功能,手术损伤小,康复快。
Objective To investigate the primary clinical efficacy of Collinear clamp assisted reduction and proximal femoral nail antirotation(PFNA) in the treatment of medial-lateral irreducible intertrochanteric fractures. Methods From January 2012 to December 2016, a total of 21 cases of medial-lateral irreducible intertrochanteric fractures of femur who were treated with Collinear clamp assisted reduction and PFNA in Lishui Hospital of Zhejiang University were selected.There were 12 males and 9 females, with a mean age of 76.7 years(ranged 51 to 91). According to Arbeitsge-meinschaft für Osteosynthesefragen/The Association for the Study of Internal Fixation(AO/ASIF) classification, there were 6 cases of type 31-A1 fractures, 11 cases of type 31-A2 fractures, 4 cases of type 31-A3 fractures.All patients were followed and the clinical results and functional rehabilitation were evaluated during perioperative period and after short term followed-up. Results The mean operation time was 61.7min(ranged 40-110min). The mean intraoperative blood loss was 131.7mL(ranged 45-450mL). The average hospitalization days was 13.6d(ranged 7-29d). There were no severe complications and exacerbation of coexisting medical disease.All patients were followed up for 10 to 18 months (average 13.3 months) after treatment.The fracture union was obtained in all patients at the final follow-up.No poor healing, failure of internal fixation, cut-out of proximal screws, varus deformity, re-fractures occurred after operation.The clinical results were evaluated according to Harris hip score, 6 cases achieved excellent results, 13 cases were good, 2 cases were fair at last follow-up.The excellent and good rate of the hip joint function was 90.5%. Conclusion Surgical treatment of medial-lateral irreducible intertrochanteric fractures with Collinear clamp assisted reduction and PFNA can result in excellent reduction and function.This technique has less injury and faster recovery.However, the long-term effect needs to evaluate by follow-up.
作者
黄淑明
兰树华
吴泉州
郑荣宗
Huang Shuming;Lan Shuhua;Wu Quanzhou;Zheng Rongzong(Department of Orthopedics, Lishui Hospital of Zhejiang University (Lishui Central Hospital), Lishui, Zhejiang 323000, China)
出处
《中国基层医药》
CAS
2019年第9期1037-1041,共5页
Chinese Journal of Primary Medicine and Pharmacy
基金
浙江省医药卫生科技计划项目(2015KYB450)
浙江省丽水市科技局高层次人才培养资助项目(2016RC19).
关键词
骨折固定术
髓内
髋骨折
外科手术
微创性
Fracture fixation, intramedullary
Hip fractures
Surgical procedures, minimally invasive
