Gamma钉治疗左侧股骨粗隆间骨折导致头颈骨块旋转

Head-neck fragment rotational displacement during wrenching-in lag screw in left-sided intertrochanteric fractures treated with Gamma-3

目的 探讨顺时针拧入Gamma-3的拉力螺钉时,是否造成头颈骨块的旋转而加大骨块间分离.方法 回顾性分析2013年1月-12月收治的左侧股骨粗隆间骨折32例,均接受闭合复位Gamma-3内固定治疗.在患肢中立位侧位片上,测量头颈骨块轴线与股骨干轴线的成角,比较该角度在闭合复位后、拧入拉力螺钉后及出院前的变化.结果 在术中拧入头颈部拉力螺钉后,头颈骨块发生顺时针旋转分离的有9例,下方皮质向前上翘起.骨折分型OTA31 A2.3,均为不稳定型顺向粗隆间骨折.头颈骨块轴线和股骨干轴线的夹角,骨折闭合复位后为16.78°±4.55°,拧入拉力螺钉后为27.78°±6.0°,回拧后为17.67°±4.30°,出院时为17.89°±3.89°.经统计学分析,拧入拉力螺钉能显著加大头颈骨块的顺时针旋转（P＜0.05）,反向回拧后分离角度显著减少（P＜0.05）.结论 拉力螺钉在拧入头颈骨块时有造成其顺时针旋转的倾向,对左侧粗隆间骨折能加大头颈骨块的旋转分离.

Objective To explore whether insertion of the lag screw into the head-neck fragment in left-sided intertrochanteric fractures can cause fragment rotation and loss of reduction. Methods A retrospectively analysis was performed in 32 patients with left-sided unstable intertrochanteric fracture, who underwent close reduction and Gamma-3 fixation from January to December 2013. The angle between the central axis of head-neck and the central axis of femur shaft in lateral X-ray film was measured, and compared among closed reduction, lag screw insertion, and final state before patient discharge. Result When lag screw was wrenched into the head-neck fragment, rotational displacement was observed in 9 of 32 patients （28%）. All the 9 fractures were classified OTA31A2.3. The angle between the central axis of head-neck fragment and femur shaft was 16.78° ±4.55° after closed reduction 27.78° ±6.0° after lag screw insertion 17.67° ±4.30° after back rotation, and 17.89° ±3.89° in discharge, respectively. A statistical test revealed a significant difference between closed reduction, lag screw insertion, and back rotation of the lag screw （P 〈 0.05）. Conclusion Wrenching-in lag screw can potentially lead to head-neck fragment rotation and loss of fracture reduction in unstable leftsided intertrochanteric fractures.