徒手牵引复位髓内固定治疗股骨转子间骨折35例分析

Effect of intramedullary fixation under the manual tranction reduction in the treatment of femoral intertrochanteric fractures in 35 case

目的：探讨徒手牵引复位,髓内固定治疗股骨转子间骨折的手术策略及临床疗效。方法：回顾性分析35例股骨转子间骨折患者的临床资料,患者均在徒手牵引复位下,采用髓内固定的手术治疗方法。观察术中出血量,术后1、3、6个月和1年门诊随访,每次摄片观察骨折愈合及骨化性肌炎发生情况。采用Harris评分标准对髋关节功能恢复的情况进行评估。结果：35例患者中30例接受1~59个月随访。单纯股骨近端防旋髓内钉（ PFNA）内固定30例,PFNA联合股骨颈加压空心螺纹钉1例,联合加压交锁髓内钉系统内固定4例；闭合复位31例,切开复位4例。 Harris功能评分显示,优16例,良10例,可3例,差1例,优良率为86.7%。术中继发股骨干内侧骨皮质劈裂1例,术后第2天继发腔隙性脑梗死1例,经对症治疗后痊愈出院。随访的30例患者均无感染及内固定失效发生,骨折均正常愈合。术后15个月因车祸致内固定远端骨折1例。结论：髓内固定是治疗股骨转子间骨折的有效方法,徒手牵引复位同样能够达到理想的治疗效果,但需要注意手术操作技巧。

Objective：To explore the operation methods and clinical effects of intramedullary fixation under the manual tranction reduction in the treatment of femoral intertrochanteric fractures. Methods：The clinical data of 35 patients with femoral intertrochanteric fractures were retrospectively analyzed. All patients were treated with intramedullary fixation under the manual tranction reduction,the intraoperative blood loss was observed. The fracture healing and myositis ossificans occurrence were detected by radiograpy at postoperative l,3,6 months and 1 year. The hip joint function recovery of patient was evaluated using Harris scoring system. Results：Among 35 patients,30 cases were followed up for 1 to 59 months. 30 cases were treated with PFNA,1 case was treated with PFNA combined with femoral neck pressure hollow screw nails and 4 cases were treated with intertan nails. Closed reduction in 31 cases and open reduction in 4 cases were implemented. According to the Harris score,16 cases were excellent,10 cases were good,3 cases were fair and 1 case was bad,the excellent and good rate of which was 86. 7%. One case was accompanied with femoral medial cortical bone fracture during operation. One case was lacunar cerebral infarction at postoperative 2 days,and it recovered after symptomatic treatment. Among 30 cases with following-up,there was not infection and internal fixation failure,and all the fractures healed. The distal fractures of internal fixation in 1 case was caused by car accident. Conclusions：Intramedullary fixation is an effective method for treating the femoral intertrochanteric fractures. Unarmed manual traction reset can also achieve the ideal treatment effect, but the operation skills should be paid more attention to.