联合加压交锁髓内钉修复股骨转子间骨折的临床应用和设计优势

interTan compression interlocking intramedullary nail for femoral intertrochanteric fractures: clinical application and design advantages

背景:对于股骨转子间骨折的治疗尚无统一方式,过去应用的动力髋螺钉内固定具有一定缺陷,逐步被髓内钉内固定所取代。interTan是由美国Smith Nephew公司针对转子间骨折特点设计的联合加压交锁髓内钉,独特的加压螺纹设计具有可控的线性加压,且具有Z效应防旋的稳定性。目的:分析interTan联合加压交锁髓内钉治疗股骨转子间骨折的临床疗效及优越性。方法:2011年1月至2012年12月期间在北京朝阳急诊抢救中心骨科接受interTan联合加压交锁髓内钉内固定治疗的股骨转子间骨折患者60例纳入研究的实验组,2009年1月至2010年12月期间北京朝阳急诊抢救中心骨科60例接受动力髋螺钉治疗的股骨转子间骨折者为对照组。结果与结论:实验组患者的内固定中出血量、内固定后下床活动时间、疼痛数字评分、影像学完全愈合时间、完全负重下地时间均低于对照组;内固定后3个月、半年以及1年时,实验组患者的Harris髋关节评分和HSS膝关节评分均高于对照组。提示相比动力髋螺钉,interTan联合加压交锁髓内钉因其设计而具有独特的稳定性,内固定能够减小手术创伤、促进骨折愈合、改善关节功能,治疗股骨转子间骨折具有良好的临床疗效。

BACKGROUND：There is no unified method for treatment of intertrochanteric fracture. Previous dynamic hip screw fixation has some shortcomings, and is gradual y replaced by intramedul ary nail fixation. interTan is a compression interlocking intramedul ary nail designed by Smith Nephew in USA according the characteristics of intertrochanteric fracture. Unique design of pressurized screw thread has control able linear pressure. Moreover, it has the stability of Z-effect anti-rotation. OBJECTIVE：To analyze the clinical therapeutic effects and superiority of interTan compression interlocking intramedul ary nail for intertrochanteric fracture. METHODS：A total of 60 patients with intertrochanteric fracture undergoing interTan compression interlocking intramedul ary nail in the Department of Orthopedics, Beijing Chaoyang Emergency Rescue Center from January 2011 to December 2012 were enrol ed in the experimental group. A total of 60 patients with intertrochanteric fractures receiving dynamic hip screw fixation in the Department of Orthopedics, Beijing Chaoyang Emergency Rescue Center from January 2009 to December 2010 were enrol ed in the control group. RESULTS AND CONCLUSION：Peri-operative bleeding volume, postoperative ambulation time, numerical rating scale score, radiographic healing time and weight-bearing time in the experimental group were lower than those of control group. At 3, 6 months and 1 year after fixation, Harris score and hospital for special surgery knee score were higher in the experimental group than in the control group. These data indicated that compared with dynamic hip screw, interTan compression interlocking intramedul ary nail has unique stability due to its design. Internal fixation can reduce operation trauma, promote fracture healing and improve joint function, and exhibit good clinical therapeutic effects for intertrochanteric fractures.