高位股骨转子下骨折的手术治疗

Operation treatment for 38 cases of high subtrochanteric fracture

目的：探讨使用复位钳对高位股骨转子下骨折进行小切口辅助复位，然后行髓内钉内固定，在骨折手术治疗中的应用价值。方法回顾重庆市南川区人民医院自2007年12月至2010年12月以来收治的38例高位股骨转子下骨折患者，其中男22例，女16例，年龄14～80岁，平均53岁。均采用复位钳经附加外侧小切口复位骨折，再插入髓内钉，固定方式均为静态锁定。其中7例患者术中使用了单扎钢丝辅助固定。平均随访时间为术后14个月。通过影像学资料评估复位质量以及骨折愈合情况。结果38例患者中，34例达到解剖复位，4例骨折近端有轻微外翻畸形（在2°～5°围内），但无并发症发生。其中37例骨折愈合，愈合率达97．4％。结论通过使用复位钳对高位股骨转子下骨折进行辅助复位，而后行髓内钉内固定，必要时单扎钢丝捆绑固定，可获得优良的复位质量，并且骨折愈合率高。术中需仔细操作，尽量减少软组织的损伤。整个手术操作简单，宜在基层医院应用推广。

Objective Through the reduction forceps assisted reduction on high subtrochanteric fracture ,and then underwent intramedullary nail fixation ,to evaluate the healing rate of the operation method and the quality of reduction of fracture .Methods Review 38 cases high subtrochanteric fracture in our hospital from 2007 December to 2010 December ,62 cases of male patients and 16 female patients ,mean age 53 years .Using reduction forceps with additional lateral small incision reduction of fracture ,and then implanted intramedullary nail after expanding medullary cavity ,and all fixation methods are static .Among them 7 patients used single tie wire fixation .The average follow-up period was 14 months .Assess the quality of reduction and fracture healing with the radiology .Results In the 38 patients ,34 patients achieved anatomic reduction ,4 cases of fracture of the proximal slight valgus deformity （2°-5° range） ,but no complications .Among them 37 cases were healed ,the healing rate was 97 .5% .Conclusion Through the reduction forceps assisted reduction on high subtrochanteric fracture ,and then underwent intramedullary nail ,and fix with single tie wire when necessary ,and fractures can be reseted in good quality ,and the rate of fracture healing will be high .But the operation requires careful operation ,minimize the injury of soft tissue .The operation is simple , should be popularized in primary hospital .