撑开互锁式外固定治疗股骨粗隆间骨折

Treatment of intertrochanteric fracture with bracing and interlocking external fixation

目的探讨撑开互锁式外固定治疗股骨粗隆间骨折。方法257例股骨粗隆间骨折患者,采用骨牵引1周,手法复位,透视下行经皮穿针撑开互锁式外固定架固定。术后平均4个月拔针。结果骨折愈合时间3～5个月,平均愈合时间4个月。完全复位,颈干角不变,下肢不短缩有166例,占66.1%;未能完全复位,颈干角在正常范围,下肢不短缩74例,占29.5%;未能完全复位,颈干角在正常范围,轻度嵌入,下肢短缩1～1.5cm11例,占4.4%。随访158例,随访时间3～5年,髋关节功能评估,优87例,良62例,差9例。优良率达94.3%。结论撑开互锁式外固定治疗股骨粗隆间骨折,不影响膝、髋关节的功能,对骨折处血供损伤小,固定稳妥,可早期下床活动,疗效满意。对年龄较大,同时患有多种疾病,不适宜于行开放手术的患者是一个较好的治疗方法。

Objective To approach treatment methods of intertrochanteric fracture with bracing and interlocking external fixation. Methods 257 patients with intertrochanteric fracture have been reviewed. All were treated with manipulative reduction and skeletal traction at flint. After one week, depending on perspective ,the patients were treated by transcutaneously threading nall into femoral head, and using a bracing and interlocking external fixation. The external fixation was removed about 4 months later. Results The clinical union of fracture ranged from 3 to 5 months, with an average of 4 months. 166 （66. 1% ） cases were completely reduced and the collodiaphyseal angle was in normal range. Seventy -four （239.5%） cases failed to completely reduce and the eollodiaphyseal angle was in normal range. Eleven （4.4%） cases failed to completely reduce, broken ends of fractured bone were partly intercalary and lower limbs were decurtated about 1 ～ 1.5 era. 158 cases were followed - up for 3 to 5 years. Based on hip joint＇s functional assessment ,the function of 87 cases was excellen,of62 good and of 9 poor with the excellent and good rate being 94.3%. Conclusion The treatment of intertrochanteric fracture with bracing and interlocking external fixation did not influence the function of knee and hip joint and had a little damage to the blood supply of broken fracture sites, and the fixation was firm and safe. The patients could ambulate early and the therapeutic effect was satisfactory. It＇s suitable choice for old patients who were troubled with many diseases and unsuitable to he operated.