摘要
目的探讨股骨大转子分离骨块对股骨转子间骨折内固定治疗效果的影响。方法回顾分析2021年5月至2023年5月82例采用股骨近端髓内钉内固定术治疗,伴有股骨大转子后方分离骨块的股骨转子间骨折患者。根据愈合位置满意情况,分为A组(愈合位置满意)38例和B组(愈合位置欠佳)44例,比较两组术后1年的Harris髋关节评分(Harris hip score,HHS)、视觉模拟评分(visual analog scale,VAS)及患侧髋关节外展活动度。结果82例患者接受手术治疗,术后影像显示内固定良好,部分患者股骨大转子后方有分离或骨皮质不连续,术后3~4个月81例骨折愈合良好,1例术后6个月愈合,平均愈合时间3.9个月。术后1年,14.6%的患者股骨大转子后方骨块愈合不良,未见内固定失效,15例患者有轻微股骨远端内翻畸形。术后1年两组HHS和VAS差异无统计学意义(P>0.05),但B组髋关节外展活动度明显小于A组[(26.11±5.09)°vs.(30.22±5.12)°],差异有统计学意义(P<0.05)。术后测量颈干角A组(135.6±5.8)°显著大于B组(130.5±6.1)°,前倾角A组(10.3±2.9)°显著小于B组(14.2±3.5)°,差异均有统计学意义(P<0.001);术后A3型骨折的颈干角改善程度(8.2±3.1)°显著低于A1型(12.1±2.8)°与A2型(10.5±3.3)°,差异均有统计学意义(P=0.003,P=0.021);前倾角偏移量在A3型中最大,为(4.3±1.9)°,显著高于A1/A2型(2.1±0.8)°(P<0.05)。A组与B组相比,A3型仍维持更优的颈干角[(133.8±6.2)°vs.(128.7±5.9)°]及更小前倾角偏移[(1.8±0.7)°vs.(3.9±1.5)°],差异均有统计学意义(t=2.17,P=0.013;t=5.02,P<0.001)。结论股骨大转子后方分离骨块影响骨折内固定效果,术后HHS和VAS差异无统计学意义,但愈合位置不佳的患者髋关节外展受限,骨块愈合位置影响术后功能恢复,尤其是外展活动,进行髓内钉内固定术时,应重视骨块复位和固定,以改善功能恢复。
Objective To investigate the effects of internal fixation on intertrochanteric fracture of the femur with separated greater trochanter.Methods Review and analyse 82 patients treated with proximal femoral intramedullary nailing for intertrochanteric fractures associated with posterior separation of the greater trochanter from May 2021 to May 2023.Patients were divided into Group A(satisfactory healing position)with 38 cases and Group B(unsatisfactory healing position)with 44 cases based on the satisfaction of the healing location.The Harris hip score(HHS)for hip joint function,pain(Visual Analog Scale,VAS)scores,and external rotation range of the affected hip joint at one year post-surgery were compared between the two groups.Results Eighty-two patients underwent surgical treatment,and postoperative imaging showed good internal fixation.Some patients had separation or discontinuity of the bone cortex behind the greater trochanter of the femur.Eighty-one patients had good fracture healing 3 to 4 months after surgery,with one patient healing 6 months postoperatively.The average healing time was 3.9 months.One year after surgery,14.6%of patients had poor healing of the bone mass behind the greater trochanter of the femur,but no failure of internal fixation was observed.Fifteen patients had mild distal femoral varus deformity.There was no statistically significant difference in HHS and VAS scores between the two groups one year after surgery(P>0.05),but the hip joint abduction range of motion in Group B was significantly smaller than in Group A[(26.11±5.09)°vs.(30.22±5.12)°],with statistically significant differences(P<0.05).The neck-shaft angle in Group A was significantly larger than Group B postoperatively[(135.6±5.8)°vs.(130.5±6.1)°],while the anteversion angle was smaller[(10.3±2.9)°vs.(14.2±3.5)°],with statistically significant differences(P<0.001).Postoperative improvement of the neck-shaft angle in A3-type fractures(8.2±3.1)°was significantly lower than that in A1-type(12.1±2.8)°and A2-type(10.5±3.3)°,with statistically significant differences(P=0.003,P=0.021).The anteversion angle deviation was the greatest in A3-type at(4.3±1.9)°,which was significantly higher than in A1/A2-type(2.1±0.8)°with statistically significant differences(P<0.05).Compared with Group B,Group A still maintained a better neck-shaft angle[(133.8±6.2)°vs.(128.7±5.9)°]and a smaller anteversion angle deviation[(1.8±0.7)°vs.(3.9±1.5)°],with statistically significant differences(t=2.17,P=0.013;t=5.02,P<0.001).Conclusions The separation of bone fragments behind the greater trochanter of the femur affects the internal fixation outcome of fractures.There is no significant difference in postoperative HHS and VAS scores for hip joint function,but patients with poor healing positions experience limited hip abduction.The healing position of bone fragments impacts postoperative functional recovery,especially in abduction activities.When performing intramedullary nail fixation,it is important to emphasize the reduction and fixation of bone fragments to improve functional recovery.
作者
郭建
郭月超
王哲
张玉舰
GUO Jian;GUO Yue-chao;WANG Zhe;ZHANG Yu-jian(Orthopedics Department,Qinhuangdao First Hospital,Qinhuangdao,Hebei,066000,China)
出处
《中国骨与关节杂志》
2025年第9期775-781,共7页
Chinese Journal of Bone and Joint
基金
河北省医学科学课题研究计划(20240650)。
关键词
髋骨折
骨折固定术
内
分离骨块
Hip fractures
Fracture fixation,internal
Separated bone fragment
