摘要
目的探究内侧皮质不同复位等级对股骨转子间骨折(FIF)股骨近端髓内钉内固定术后临床疗效的影响。方法选取2016年6月至2019年10月正阳县人民医院收治的76例FIF患者作为研究对象,并根据股骨近端髓内钉内固定术后即刻正位X线片显示的头颈骨块内侧皮质和股骨干内侧皮质的位置关系将患者分为正性支撑组(25例)、中性支撑组(26例)和负性支撑组(25例),其中正性支撑组患者头颈骨块内侧皮质位于股骨干内侧皮质内上方,中性支撑组患者头颈骨块内侧皮质与股骨干内侧皮质影像学上完全对位,负性支撑组患者头颈骨块内侧皮质位于股骨干内侧皮质外上方。对比观察3组患者术中出血量、手术时间、术后即刻尖顶距(TAD)、骨折愈合时间、股骨颈长度及颈干角变化情况以及临床疗效与并发症发生情况。结果3组患者术中出血量、手术时间及术后即刻TAD无明显差异(F=0.021、0.015、0.255,P=0.980、0.985、0.880)。正性支撑组患者骨折愈合时间明显短于负性支撑组(q=5.373,P<0.001),而正性支撑组和中性支撑组、中性支撑组和负性支撑组间无明显差异(q=3.145、2.280,P=0.074、0.246)。术后即刻及术后3个月,正性支撑组患者股骨颈长度均明显长于中性支撑组和负性支撑组(术后即刻:q=6.172、13.920,P均<0.001;术后3个月:q=16.240、30.600,P均<0.001),且中性支撑组患者股骨颈长度明显长于负性支撑组(q=7.887、14.660,P均<0.001);正性支撑组患者颈干角均明显大于中性支撑组和负性支撑组(术后即刻:q=3.562、7.839,P=0.037、P<0.001;术后3个月:q=12.360、24.860,P均<0.001),且中性支撑组患者颈干角明显大于负性支撑组(q=4.353、12.740,P=0.008、P<0.001)。术后6个月,正性支撑组患者中优15例、良8例、中1例、差1例,明显优于中性支撑组患者的优8例、良8例、中7例、差3例以及负性支撑组患者的优6例、良7例、中6例、差6例(Z=-2.520、-3.
Objective To investigate the influence of reduction with different medial cortical supports on the clinical efficacy of intramedullary nailing at proximal femur for femoral intertrochanteric fracture(FIF).Methods 76 patients with FIF,admitted into Zhengyang People’s Hospital between June 2016 and October 2019,were enrolled as research subjects,and divided into positive buttress group(n=25),anatomic reduction group(n=26)and negative buttress group(n=25)based on the positional relation between proximal fracture fragment(femoral neck and head)and distal femoral neck fragment from the anteroposterior view of X ray immediately after the intramedullary nailing at proximal femur.In positive buttress group,the proximal fracture fragments of patients were displaced medially to the upper medial edge of the distal femoral neck fragment;in anatomic reduction group,the proximal fracture fragment of patients were positioned exactly into the medial edge of the distal femoral neck fragments based on imaging,while in negative buttress group,the distal femoral neck fragments of patients were positioned medially to the lower-medial edge of the proximal fracture fragments.Intraoperative blood loss,operation time,tip apex distance(TAD)immediately after surgery,fracture healing time,changes of femoral neck length and neck shaft angle,clinical efficacy and occurrence of complications were compared among the three groups.Results The intraoperative blood loss,operation time and TAD immediately after surgery presented no significant differences among the three groups(F=0.021,0.015 and 0.255,P=0.980,0.985 and 0.880).The fracture healing time was obviously shorter in positive buttress group than negative buttress group(q=5.373,P<0.001),while no significant difference was observed respectively between positive buttress group and anatomic reduction group,and between anatomic reduction group and negative buttress group(q=3.145 and 2.280,P=0.074 and 0.246).Immediately after surgery and 3 months after surgery,the femoral neck lengths of patien
作者
孔波
孙清国
张威
KONG Bo;SUN Qingguo;ZHANG Wei(Department of Orthopedics,Zhengyang People’s Hospital,Zhumadian,Henan 463600,China)
出处
《中国烧伤创疡杂志》
2022年第4期262-266,共5页
The Chinese Journal of Burns Wounds & Surface Ulcers
关键词
股骨转子间骨折
髓内钉内固定
内侧皮质
正性支撑复位
稳定性
Femoral intertrochanteric fracture
Intramedullary nailing
Medial cortical supports
Positive buttress reduction
Stability
