股骨重建钉治疗多发性骨软骨瘤患者粗隆间骨折合并同侧粗隆下骨折

Femoral reconstruction nail for the treatment of intertrochanteric and ipsilateral subtrochanteric fractures in patients with multiple exostoses

目的探讨股骨重建钉治疗多发性骨软骨瘤患者粗隆间骨折合并同侧粗隆下骨折的临床疗效。方法 2009年1月至2010年6月我科使用股骨重建钉治疗多发性骨软骨瘤患者粗隆间骨折合并同侧粗隆下骨折18例,男13例,女5例;其中有侧10例,左侧8例;年龄23～69岁,平均(48.5±2.7)岁。股骨粗隆间骨折按Evans标准分类,Ⅰ型1例,Ⅱ型2例,ⅢA型6例,ⅢB型4例,Ⅳ型3例,V型2例全部合并同侧粗隆下骨折,根据Russell-Tavlor分型,ⅠA型6例,ⅠB型8例,ⅡB型4例。所有患者的影像学资料均提示为全身多发性骨软骨瘤。随访患者骨折术后并发症的发生情况、临床愈合时间及功能评分。结果 18例患者均获得随访,随访时间12-30个月,平均(24.2±0.8)个月。手术时间75-135min,平均(105±6.5)min。术后住院时间为7-12d,平均(9.3±1.2)d。末次随访时的Harris评分为65～95分,平均(86.6±3.4)分,其中优7例,良8例,中2例,差1例,优良率83.33%。骨折愈合时间12-20周,平均为(16.2±1.8)周。末次随访时除1例出现头钉切割股骨头和1例出现髋内翻外,无骨折再移位,无内固定失效,无股骨头缺血性坏死,无感染发生等并发症。结论股骨重建钉治疗多发性骨软骨瘤患者粗隆间骨折合并同侧粗隆下骨折取得良好临床效果.具有手术相对简单,创伤小,固定牢固。

Objective To investigate the clinical effects of femoral reconstruction nail for the treatment of subtrochanteric and ipsilateral subtrochanteric fractures in patients with multiple exostoses. Methods From January 2009 to June 2010, a total of 18 patients with multiple exostoses were treated with femoral reconstruction nail for intertrochanteric and ipsilateral subtrochanteric fractures in our department. Among them there were 13 males and 5 females, whose average age was 48.5＋2.7 years old （range; 23-69 years）, There were 10 cases on the right side and 8 cases on the left side. In the intertrochanteric fractures group, according to Evans classification, there were 1 case of type Ⅰ, 2 of type Ⅱ, 6 of type Ⅲ A, 4 of type Ⅲ B, 3 of type Ⅳ and 2 of type Ⅴ. In the ipsilateral subtrochanteric fractures group, according to the Russell-Taylor classification, there were 6 cases of type Ⅰ A, 8 of type Ⅰ B and 4 of type ⅡB. Imaging material of all patients indicated as general multiple exostoses. The occurrence of complications after fracture operation, clinical healing time and functional evaluation of all patients were followed up. Results All the 18 patients were followed up over an average period of 24.2±0.8 months （range; 12-30 months）. The mean operation time was 105±6.5 minutes （range; 75-135 minutes）, and the mean postoperative hospital stay was 9.3±1.2 days （range; 7-12 days）. The average Harris score in the final follow-up was 86.6±3.4 scores （range; 65-95 scores）. Among the 18 patients, 7 patients were excellent, 8 good, 2 fair and 1 poor. The excellence rate was 83.33%. The mean healing time of the fractures was 16.2±1.8 weeks （range; 12-20 weeks）. In the final follow-up, except for 1 patient with nail cutting the femoral head and 1 patient with coxa vara, there was no complication such as fracture redisplacement, failure of internal fixation, avascular necrosis of femoral head, infection and so on. Conclusions Femoral reconstruction nail for the treatment of subtrochanteric and ipsilateral subtrochanteric fractures in patients with multiple exostoses has good clinical effects. It has such advantages as relatively simple surgery, less surgical trauma, rigid fixation, early functional exercises and rare complications for patients and so on.