股骨转子间骨折髓内固定物治疗的优劣评说

Intramedullary fixation for the treatment of femoral intertrochanteric fracture: Pros and cons evaluation

背景:随着股骨转子间骨折发生率的不断上升,它的治疗方法也不断更新,当前治疗股骨转子间骨折的方法很多,就生物力学而言,髓内固定较髓外固定更加具有优势。目的:综述股骨转子间骨折髓内固定治疗方法的发展及现状,分析各种方法的利弊,展望股骨转子间骨折髓内固定治疗的发展。方法:以Intertrochanteric fracture,Intramedullary nail,Gamma nail,Proximal femoral nail,InterTan为英文检索词检索Pubmed数据库,以转子间骨折,髓内固定,伽马钉,股骨近端髓内钉,联合拉力交锁髓内钉为中文检索词检索CNKI数据库和中国知网数据库中2001至2012年发表的相关文献,纳入有关股骨转子间骨折髓内固定治疗的文献和有关治疗股骨转子间骨折内固定物的文献。共检索到115篇文献,排除无关重复的文献,保留54篇进行综述。结果与结论:对于不稳定型转子间骨折,髓内固定系统在生物力学上具有优势,更靠近重心,力臂较短,髓内钉能更可靠的对抗沿股骨距传导的应力,并可防止股骨干内移。Gamma钉、股骨近端髓内钉、股骨近端抗旋髓内钉、可膨胀股骨近端髓内钉、微创短重建钉、联合接力交锁髓内钉在临床应用上可以达到骨折复位满意、坚强内固定的要求。而人工髋关节置换可应用于一些骨折不稳定、高龄老年人并且合并内科疾病及严重骨质疏松的患者。随着学者们对生物力学的研究和重新认识,内固定物的变革更新,手术技术的进一步发展,治疗股骨转子间骨折的方法和疗效会有更大的提高。

BACKGROUND： With the increasing of the incidence of femoral intertrochanteric fracture, the treatment method is developed. There are many methods for the treatment of femoral intertrochanteric fracture, and intramedullary fixation has more advantages when compared with extramedullary fixation in biomechanics. OBJECTIVE： To review the development and current state of intramedullary fixation for the treatment of femora intertrochanteric fracture, to analyze the pros and cons of each method and to prospect the future of intramedullary fixation for the treatment of femoral intertrochanteric fracture. METHODS： The PubMed database, CNKI database and CAJ database were retrieved by computer with key words of ＂intertrochanteric fracture, intramedullary nail, Gamma nail, proximal femoral nail, locking intramedullary nail＂ in English and Chinese for the related articles published from 2001 to 2012. The literatures about or related with intramedullary fixation for the treatment of femoral intertrochanteric fracture were included. A total of 115 articles were screened out, the repetitive researches were excluded, and finally 54 articles were included for review. RESULTS AND CONCLUSION： For the unstable intertrochanteric femoral fracture, intramedullary fixation has superiority in the biomechanics, because it more closes to the center of gravity and its force arm is shorter. Intramedullary nail can against the conductive stress along with calcar femorale well and can prevent the femoral shaft ingression. Gamma nail, proximal femoral nail, proximal femoral nail anti-rotation, expandable proximal femoral intramedullary nail, minimally invasive short reconstructive intramedultary nail and locking intramedullary nail can achieve the satisfactory reduction and nail rigid internal fixation in clinic. The artificial hip replacement can be used for the treatment of the patients with unstable, elderly and combined with the medical disease and severe osteoporosis fractures. With the rediscover of biomechanics, changes and updates of the internal fixation and the development of operation, the method and effect for the treatment of femoral intertrochanteric fracture will be improved.