髓内钉内固定治疗伴外侧壁损伤的股骨粗隆间骨折

Intramedullary nail fixation for femoral intertrochanteric fractures with lateral trochanteric wall injury

目的 评价髓内钉内固定治疗伴外侧壁损伤的股骨粗隆间骨折的临床疗效。方法 回顾性分析2009-02—2012-02采用髓内钉内固定治疗的22例伴外侧壁损伤的股骨粗隆间骨折。重建钉内固定10例,股骨近端髓内钉（PFN）内固定5例,Gamma钉内固定3例,股骨近端防旋髓内钉（PFNA）内固定2例,Inter Tan内固定2例。在X线片上测量术后早期、3个月及1.5年的颈干角（NSA）及股骨头颈轴长（FNLA）。末次随访时采用髋关节功能Harris评分评估疗效。结果本组手术时间70~150 min,平均95 min;术中出血量50~250 ml,平均120 ml。住院时间10-41 d,平均21 d。22例获得平均22.5（19~28）个月随访。骨折临床愈合时间9~15周,平均11.3周。2例术中经导向器置入远端锁钉失败,于C型臂X线机监视下徒手置钉成功;2例术后出现股骨头颈螺钉退出;3例术后双下肢不等长,差值均〈1.5 cm;2例术后患肢外旋,外旋角度均〈10°。术后早期、3个月及1.5年NSA、FNLA差异无统计学意义（P〉0.05）。末次随访时髋关节功能Harris评分平均91.4（78~98）分。结论 采用髓内钉内固定治疗伴外侧壁损伤的股骨粗隆间骨折能提供持续、稳固的固定,有效防止骨折再移位,允许早期功能锻炼,可取得良好的临床疗效。

Objective To evaluate the clinical effect of intramedullary nail fixation for treatment of femoral intertrochanteric fractures with lateral trochanteric wall injury.Methods From February 2009 to February 2012,22 patients suffered from femoral intertrochanteric fractures with lateral trochanteric wall injury were treated by intramedullary nail fixation.The types of intramedullary nail included：reconstruction nail in 10 cases,PFN in 5,Gamma nail in 3,PFNA in 2,Inter Tan in 2.The neck shaft angle（NSA） and femoral neck long axis（FNLA） were measured on the X-ray films in the early postoperative period,at the3 rd month and 1.5 year postoperatively.The effect was evaluated according to the Harris score at the last follow-up.Results The operation duration was 70-150 min（mean,95 min）,the blood loss was 50-250 ml（mean,120 ml）,and the hospitalization time was 10-41 d（mean,21 d）.All 22 cases were followed up,and the period was 19-28 months（mean,22.5 months）.The fracture healing time was 9-15 weeks（mean,11.3 weeks）.Distal locking failed by guide device in 2 cases,and succeeded under C-arm fluoroscopy by free hand.Femoral neck screw disengaged in 2 cases.Leg length discrepancy occurred in 3 cases,and the difference was 〈1.5 cm.External rotation of the affected limb occured in 2 cases,and the angle was〈 10°.A comparison concerning NSA and FNLA in the early postoperative period,at the 3rd month and 1.5 year postoperatively was performed,the difference was not significant（P 〉0.05）.The mean Harris score at the last follow-up was 91.4（78-98）.Conclusion In the treatment of femoral intertrochanteric fractures with lateral trochanteric wall injury,intramedullary nail fixation can provide durable and stable fixation,avoid the replacement,allow patients to do exercise early,and achieve an excellent clinical outcome.