股骨小转子骨折固定复位器的设计与临床应用

Design of the reduction fixator and its clinical application in treating fracture of lesser trochanter of femur

目的 ：探讨小转子复位固定在转子间骨折治疗中的临床意义。方法 ：自2012年1月至2013年12月,治疗32例不稳定性转子间骨折患者,其中男11例,女21例;年龄45~81岁,平均64岁。EvansⅡ型12例,Ⅲ型13例,Ⅳ型7例。均采用自行设计的爪式可控复位固定器进行小转子复位。固定方法：单纯使用拉力螺钉19例,使用钢丝13例。通过观察患者髋内翻、股骨头颈切割、钉板断裂等情况,以及髋关节功能（采用Harris关节功能评分）来分析疗效。结果：32例患者均获得随访,时间9个月~2年,平均13个月。32例患者中发生髋内翻1例,无股骨头颈切割及钉板断裂。髋关节功能评分为91.80±3.05。结论：后内侧骨皮质连续性的重建和固定是影响股骨转子间骨折稳定性的关键因素,采用自行设计的爪式可控复位固定器可在术中有效的复位固定小转子,具有快速复位和固定、操作简捷的优点。

Objective：To discuss the clinical significance of the reduction and fixation for femoral lesser trochanteric fragment in treating the femoral comminuted intertrochanteric fractures. Methods：From January 2012 to December 2013,32 patients with intertrochanteric fractures were treated by surgery,and self designed reduction fixators were used in the patients for the fixation of lesser trochanter of femur. There were 11 males and 21 females,ranging in age from 45 to 81 years old with an average of 64 years old. According to the Evans typing,12 cases were typeⅡ,13 cases were type Ⅲ and 7 cases were typeⅣ. Simple lag screw fixed in 19 cases and steel wire fixed in 13 cases. Hip joint function was evaluated according Harris score and the complications such as coxa adducta,cutting of femoral head and neck,implants breakage were observed. Results：Thirty two patients were followed up from 9 to 24 months with an average of 13 months. Coxa adducta occurred in 1 case,no cutting of femoral head and neck occurred and implants breakage were found. The mean Harris score was 91.80±3.05 in 32 patients. Conclusion：The reconstruction and fixation for the posterior medial bone cortex continuity is a key factor on affect the stability of femoral intertrochanteric fracture. Self designed reduction fixators can effective reduce and fix the lesser trochanter of femur,it has advantage of fast reduction and fixation,and simple operation.