股骨重建钉治疗股骨干骨折合并同侧股骨转子周围骨折的疗效分析

Clinical analysis of reconstruction interlocking nail in surgical treatment of femoral shaft fractures associated with ipsilateral peritrochanteric fractures of the femur

[目的]探讨股骨干骨折合并同侧股骨转子周围骨折的股骨重建钉(RIN)内固定手术治疗方法并评估其临床效果。[方法]对2002年9月～2009年1月通过RIN手术治疗的累及同侧股骨转子周围部的37例股骨干骨折患者的治疗结果进行分析。男32例,女5例,年龄24～69岁,平均36岁。高能量损伤33例(交通事故伤26例,高处坠落伤7例),低能量损伤4例(均为运动中跌倒摔伤)。股骨干骨折发生在上1?3段13例,中1?3段18例,下1?3段6例,其中开放骨折6例(GustiloⅠ型1例,Ⅱ型5例)。股骨颈骨折按照Garden分类,Ⅱ型19例,Ⅲ型9例,Ⅳ型2例。转子间骨折按AO分类,A1.1型3例,A2.1型1例。转子下骨折按照Seinsheimer分型,Ⅰ型1例,ⅡA型2例。受伤至手术时间为4h～13d(平均3.7d)。术后进行渐进式的功能锻炼。[结果]所有患者得到14～38个月(平均24个月)随访。术后均获得骨性愈合,骨折平均愈合时间:股骨干13周,股骨颈14周,转子间12.6周,转子下15.5周。发生股骨头坏死1例。无感染、内固定断裂和松动、髋内翻及畸形愈合等并发症发生。根据Harris评分:优(91～100分)21例,良(81～90分)11例,可(71～80分)4例,差(≤70分)1例,优良率86.5%。[结论]RIN治疗股骨干骨折合并同侧转子周围骨折具有创伤小、固定可靠、骨愈合率高、并发症少和疗效好等优点,较其他方法可减少内固定数目。精心选择适应证、规范的手术操作和积极的术后康复锻炼是治疗成功的关键。

[Objective]To discuss the operative treatments and evaluate the effects of reconstruction interlocking nail（RIN）in treating femoral shaft fractures associated with ipsilateral peritrochanteric fractures of the femur.[Method]A retrospective study was done on 37 patients with femoral shaft fractures combined with ipsilateral peritrochanteric fractures treated by RIN from September 2002 to Janurary 2009.This study involved 32 males and 5 females,with an average age of 36 years （range,24 to 69 years）.Thirty-three patients had high-energy injury （26 of road accident,7 of falling from height）,and 4 low-energy injury.Among them,13 patients had fractures in the upper one-third of the femoral shaft,18 in the middle one-third and 6 in the lower one-third.Six patients had open fractures （Gustilo scale Ⅰ in 1,and Ⅱ in 5）.According to Garden classification for femoral neck fractures,there were 19 cases of type Ⅱ,9 cases of type Ⅲ and 2 cases of typ Ⅳ.According to AO classification for femoral intertrochanteric fractures,there were 3 cases of type A1.1,1 case of type A2.1.According to Seinsheimer classification for femoral subtrochanteric fractures,there was 1 case of type Ⅰ,and 2 cases of type ⅡA.The mean duration from injury to surgery was 3.7 days （range,4 hours to 13 days）.After operation step-by-step functional rehabilitation was encouraged.[Result]The follow-up periods ranged from 14 to 38 months （average,24 months）.Bony union was achieved in all patients.The average bony union time was 13 weeks for fractures of femoral shaft,14 weeks for femoral neck,12.6 weeks for intertrochanteric and 15.5 weeks for subtrochanteric fractures.Femoral head necrosis occurred in one case.No such complications as infection,loosening of nails,coxa vara,or malunion was found.According to Harris Scoring system,32 cases （86.5%）were rated as good or excellent.[Conclusion]The treatment of femoral shaft fractures associated with ipsilateral peritrochanteric fractures of the femur with RIN is a good method because of its advantages of small trauma,stable fixation,high union rate,few complications and good results.It may have fewer internal fixators.Carefully choosing suitable patients,sophisticated operation skills and active functional exercise after operation are keys to success.