头髓钉治疗股骨粗隆间骨折中远侧交锁螺钉应用的研究进展

PROGRESS ON DISTAL INTERLOCKING SCREW OF CEPHALOMEDULLARY NAIL FOR INTERTROCHANTERIC FRACTURES

目的总结采用头髓钉治疗股骨粗隆间骨折中,对远侧交锁螺钉的研究进展。方法查阅近年国内外相关文献,从远侧交锁螺钉的生物力学、临床应用、操作难点以及并发症等方面进行总结分析。结果对长型或短型头髓钉,植入远侧交锁螺钉均可增加头髓钉的整体抗扭转刚度,目前临床常规使用。使用长型头髓钉时植入远侧交锁螺钉费力耗时、射线暴露显著增加;使用短型头髓钉时植入远侧交锁螺钉可能有股内侧血管损伤、局部应力集中、二次骨折以及断钉等并发症。结论对稳定型股骨粗隆间骨折(A1、A2.1型),可不植入远侧交锁螺钉;对不稳定型粗隆间骨折,必须植入远侧交锁螺钉,防止股骨干旋转畸形。

Objective To summarize the progress on the distal interlocking screw of cephalomedullary nail for intertrochanteric fractures. Methods Related literature concerning the distal interlocking screw of cephalomedullary nail was reviewed and analyzed in terms ofbiomechanics, clinical application, operating difficulties, and complications. Results Distal interlocking screw can provide extra torsional stiffness in both short and long cephalomedullary nail. It is applied in most clinical cases. In long cephalomedullary nail, placing the distal interlocking screw increases the operative time for fixation and the amount of radiation exposure notably. In short cephalomedullary nail, placing the distal interlocking screw can cause adjacent vascular injury, stress concentration, and secondary fracture around the screw. Conclusion When the fracture is stable （type A1, type A2.1）, it can be fixed solidly without the distal interlocking screw, but prefers to use a long nail. In unstable fracture, the distal interlocking screw should be used to prevent rotational displacement of the femur shaft and the failure of the nail.