小切口辅助复位微创髓内钉固定治疗股骨粗隆间骨折12例

Mini-incision Assisted Reduction Combined with Intramedullary Nail Fixation for the Treatment of Femoral Intertrochanteric Fracture: a Report of 12 Case

目的 探讨小切口辅助复位微创髓内钉固定治疗股骨粗隆间骨折的疗效.方法 2012年6月-2013年4月,对12例术中闭合复位难以解剖复位的股骨粗隆间骨折,采用在骨折部位做纵行小切口3-5 cm,持骨器、髌钳等钳夹不能复位的骨折块,使之解剖复位,再行髓内钉插入固定治疗.结果手术时间45-80 min,平均55.4 min;术中出血量150-400 ml,平均185 ml.术后X线示复位均满意,12例随访4-15个月,平均8.1月.骨折全部愈合,愈合时间11-17周,平均14.2周,未见髋内翻畸形、内固定松动、拉力螺钉切割股骨头等现象.骨折愈合后按髋关节功能Harris 评分标准评定疗效：优10例,良2例.结论对于闭合复位不能达到满意效果的股骨粗隆间骨折,采用小切口辅助复位,可达到最佳复位,获得较好的疗效,减少并发症的发生.

Objective To explore the clinical effect of mini-incision assisted reduction combined with intramedullary nail fixation for femoral intertrochanteric fracture. Method From June 2012 to April 2013,12 patients with irreducible femoral intertrochanteric fracture were treated by intramedullary nail fixation. Mini-incision around the fracture and bone-holding clamp was made to aid fracture reduction during the operation. When the reduction of the fracture reached satisfactory stage, intramedullary nail was used to fix the fracture. Results The operation time was 45 - 80 rain （ mean, 55.4 rain ） ; the intraoperative blood loss was 150 -400 ml （mean, 185 ml）. Postoperative X-ray showed the reduction of the fracture was satisfactory. All cases were followed up for 4 - 15 months （mean, 8. l months）. Bone union was observed in all cases with the average time of 14.2 weeks （range, 11 - 17 weeks） without occurrence of yarns deformity, hardware loosening or hardware cutting botles. According to Harris Hip scores, l0 cases were rated as excellent and 2 were good. Conclusion For irreducible femoral intcrtrochanteric fracture with close reduction, miniincision can be applied around the fracture to aid fracture reduction during the surgery, which can help achieve the best results and reduce complications.