股骨重建髓内钉在股骨粗隆下骨折中的应用

Treatment of subtrochanteric femoral fractures with the femoral reconstruction intramedullary nail

目的探讨应用股骨重建髓内钉治疗股骨粗隆下骨折的疗效及其并发症发生的原因。方法 2004年1月至2009年12应用股骨重建髓内钉治疗股骨粗隆下骨折25例,其中男15例,女10例,年龄31～89岁,平均42.3岁。按Seinsheimer分型：Ⅱa型2例,Ⅱb型3例,Ⅱc例3例,Ⅲa型7例,Ⅲb型5例,Ⅳ型4例,Ⅴ型1例,其中1例为陈旧性骨折不愈合。结果 21例经6～22个月随访,平均14个月,所有患者均获得骨性愈合。无切口感染或股骨骨折、股骨颈锁钉退出等,出现髓内钉折断1例,经改用加长重建髓内钉并自体植骨后愈合;骨折复位欠佳轻度髋内翻伴骨折延迟愈合1例。根据Harris髋关节评分,优良率达96%。结论股骨重建髓内钉是治疗股骨粗隆下骨折的一种有效方法,具有微创、固定可靠、并发症少、骨折愈合率高等优点。选择合适长度股骨重建髓内钉及提高手术操作技术是避免术后并发症的关键。

Objective To study the clinical outcomes of treatment of subtrochanteric femoral fractures with the femoral reconstruction intramedullary nail and the causes of complications.Methods A total of 25 cases（15 males and 10 females ranging from 31 years old to 89 years old,averagely 42.3 years old）of subchanteric femoral fracture were fixed with femoral reconstruction intramedullary nail from January 2004 to December 2009.Based on Seinsheimer classification,there were 2 cases of type IIa,4 cases of type IIb,3 cases of type IIc,7 of type IIIa,5 of type IIIb,4 of type IV and 1 of type V.Among them there was one case of old fracture nonunion.Results 21 cases were followed up for 6 to 22 months and the average time was 14 months.Union was obtained in all the patients.The local complications included reconstruction intramedullary nail breakage in 1 case and poor fracture reduction with slight varus and delayed union in another case.The former case got union after revision with extended femoral reconstruction intramedullary nail and autologous bone graft simultaneously.No other complications such as wound infection,femoral fracture or femoral neck interlocking screw exit-out happened.According to Harris criterion,excellent or good rate of the function of the hip joint was 90.5%.Conclusion Femoral reconstruction intramedullary nail is an effective means for the treatment of subtrochanteric femoral fractures,with the advantages of minimally invasive,reliable fixation,few complications,high rate of fracture healing.Correctly selection the appropriate length of the femoral reconstruction intramedullary nail and improvement of operative techniques is the key to avoid postoperative complications.