股骨转子间骨折重建股骨距的临床解剖学研究

Clinical Anatomical Study on Reconstruction of Femoral Calcar in Intertrochanteric Fractures

目的:探讨股骨转子区的解剖学特点及股骨转子间骨折股骨距重建的方法。方法:对15具正常成人尸体进行模拟股骨转子间骨折临床手术操作使用动力髋螺钉(dynamic hip screw DHS)或Gamma钉固定,测量股骨转子区的三维解剖学数据、股骨颈螺钉进钉点和小转子平面的相对位置。结合拉力钉固定小转子,测量拉力钉的进针点、进针角度、方向和长度等。结果:股骨转子区前侧在股外侧肌、股直肌和股中间肌之间为一疏松结缔组织间隙,而后侧为大量肌肉组织的附着点。从小转子顶点通过股骨前内侧表面到股骨外侧面的长度约(5.45±0.15)cm,术中通过前内侧复位小转子。小转子突起的中点在股骨颈螺钉的进针点轴面头侧约(0.47±0.13)mm,小转子位于股骨转子区的内后侧。从DHS钢板的前侧向后内侧打入拉力钉固定小转子。Gamma钉固定后其髓内钉到股骨后侧皮质的距离为(18.9±1.8)mm,空间足以在其髓内钉的后侧打入拉力钉固定小转子。结论:通过股骨前面复位小转子,在DHS钢板前内侧或Gamma钉之髓内钉的后内侧打入拉力钉固定小转子是一种创伤小且固定牢靠的治疗股骨转子间骨折的方法。

Objective：To investigate the anatomical features of the area around the femoral calear, as well as the methods of the femoral calcar reconstruction. Methods：A total of 15 adult cadavers were harvested. Dynamic hip screw （DHS） or Gamma nail was used to simulate the clinical operation of fixing the intertroehanterie fractures. The 3-D anatomical data around the femoral calcar and the relative position between the entrance point of the lag screw and the lesser trochanter were investigated. The pulling screw was used to fix the lesser trochanter, and the point of entrance, angle, direction and length were measured. Results： There was a loose connective tissue space between vastus lateralis muscle, rectus femoris and vastus intermedius mus- cle around the area of femoral calcar, but at the posterior part of the area, there is a lot of muscles attached to the bone. The distance between the lesser trochanter and the lateral side around the femur was （5.45 ± 0.15） cm. It was easy to replace the lesser trochanter through the loose connective tissue. The center of the lesser trochanter and the entrance point of the lag screw were almost at the same level. The lesser trochanter located at the posteromedial side, so it was easy to fix the lesser chocanter in front of the DHS plate with a pulling screw. The distance between the posterior side of the Gamma nail and the posterior bony cortex was about （18.9 ± 1.8） mm, so there was enough space to insert a pulling screw to fix the lesser trochanter. Con- clusions： It is easy to replace the lesser trochanter through the anterior loose connective tissue space of the femur. Through the anteromedial side of the DHS plate and the posteromedial side of the Gamma nail, it is easy and less invasive to fix the lesser trochanter with a pulling screw. All these data can serve as references for the treatment of the intertrochanteric fractures.