体表定位在股骨近端髓内钉内固定治疗股骨粗隆间骨折中的应用

Surface location for cephalic intramedullary nail in treatment of femoral intertrochanteric fracture

目的评估体表定位辅助股骨近端髓内钉内固定治疗股骨粗隆间骨折的效果。方法自2012-01—2013-12诊治20例股骨粗隆间骨折,均行闭合复位股骨近端髓内钉内固定术。麻醉下复位后,C型臂X线机透视下以细克氏针及胸科钢丝确定正侧位进针轴线、前弓顶点及头钉进针方向。测量进针点到前弓顶点距离(E-A)以及股骨外侧皮质至股骨头软骨下骨距离(L-S),选择适当的主钉及头钉。结果本组采用Inter Tan髓内钉内固定12例,股骨近端防旋髓内钉(PFNA)内固定8例;主钉长度:180 mm 14例,200 mm 4例,160 mm 2例;头钉长度(Inter Tan统计拉力螺钉):85 mm 2例,95 mm11例,100 mm 7例。20例均一次置钉成功,体表定位时间平均15.4 min,手术时间平均32.5 min。未出现术中骨折、置钉困难等情况。E-A距离平均164.5 mm,L-S距离平均104.5 mm。结论简易体表定位方法可辅助闭合复位股骨近端髓内钉内固定治疗股骨粗隆间骨折,可缩短手术时间,顺利置钉,避免置钉困难。

Objective To study the clinical results of surface location for cephalic intramedullary nail in treatment of femoral intertrochanteric fracture.Methods From January 2012 to December 2013,20 patients with femoral intertrochanteric fracture were treated by cephalic intramedullary nail.After the fracture was reduced,antero-posterior and lateral axes,apex of anterior bow,and direction of cephalic nail were determined with 1.0 mm Kirshner wire and thoracic wire under C-arm guidance and marked.These marks were used to measure the distance between the entry point and apex of anterior bow（E-A）,and the distance between the lateral cortex and subchondral bone（L-S）,to choose the appropriate intramedullary nail and cephalic nail.Results All patients had their intramedullary nails introduced for one time.The average surface location time and operation time were 15.4 min and 48.5 min,respectively.No intraoperative complications occurred.The average E-A and L-S distances were 164.5 mm and 104.5 mm,respectively.Conclusion The simple surface location method could make the procedure easy to manipulate and avoid intraoperative complications.