摘要
目的总结小转子未累及的不稳定股骨转子间骨折的手术复位技巧。方法回顾性分析2007年1月至2010年12月收治的74例AO／OTA分型中31～A3．1和31-A3．2型股骨转子间骨折资料，男33例，女41例；年龄36-87岁，平均71岁；左侧40例，右侧34例。致伤原因：交通伤27例，跌伤43例，坠落伤3例，压砸伤1例。采用撬拨技术、Homann拉钩技术、钳夹技术、有限切开等进行复位，复位后均行股骨近端髓内钉固定治疗。记录临床和影像学结果，根据Harris髋关节功能评分标准，评价术后髋关节功能。结果74例骨折复位均在透视下进行，其中闭合复位73例，有限切开复位1例。平均手术时间（75±4）min，平均术中失血量（135±5）ml，平均透视次数（24±3）次。术后65例患者获得8-23个月的随访（平均14．5个月），骨折愈合时间为4-9个月，平均7．4个月。末次随访时Harris髋关节功能评分为87-05分，平均91-4分，其中优29例，良31例，可5例，优良率为92．3％（60／65）。结论小转子未累及的不稳定股骨转子间骨折复位困难，尤其对年龄较轻、肌肉发达的患者，需要借助一定的手术复位技巧，以取得更好的治疗疗效。
Objective To explore the operative techniques for AO/OTA type 31-A3.1 and 31-A3.2 intertrochanteric fractures fixed with intrameduallary nail. Methods Seventy-four cases of unstable intertrochanteric fracture （AO/OTA type 31-A3.1 and 31-A3.2） from January 2007 to December 2010 were analyzed retrospectively. There were 33 males and 41 females, aged from 36-87 years （mean, 71 years）. The right hip was involved in 34 patients and the left in 40 patients. The mechanism of injury was traffic injuries in 27 cases, fall damage in 43 cases, injury by falling in 3 case and crush injury in 6 cases. Percutaneous joystick technique, Homann retractor technique, clamp technique and mini-incision was applied to aid reduction during the surgery. All cases were fixed with proximal intrameduallary nail. Chnical and radiographic outcomes were recorded. The postoperative hip function was evaluated using Harris score. Results With the aid of C-arm, closed reduction was performed in 73 cases. Only one patient experienced open reduction because of failure of closed reduction. Sixty-five cases were followed up for 8 to 23 months （mean, 14.5 months）. Bone union was observed in all cases with the average time of 7.4 months （range, 8-23）. The operation time, blood loss, the frequency of X-ray exposure was 754 minutes, 135±5 ml and 24±3 times, respectively. At final follow-up, 29 cases were classified as excellent, 31 as good, and 5 as fair. The mean Harris hip score was 91.4 points （range, 87-95）. The overall rate of excellent or good result was 92.3%. Conclusion It is difficult to perform close reduction for unstable intertrochanteric hip fracture （AO/OTA type 31-A3.1 and 31-A3.2）, especially in relatively young patients. Special operative skills are necessary in some cases.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2012年第7期621-625,共5页
Chinese Journal of Orthopaedics
关键词
髋骨折
骨折固定术
内
内固定器
Hip fractures
Fracture fixation, internal
Internal fixators
