股骨距的完整性结合TAD值对顺转子间骨折术后稳定性的影响分析

The effect of posteromedial femoral neck and TAD on the stability of intertrochanteric fractures treated by proximal femoral nail

目的针对应用股骨近端带锁髓内钉内固定术治疗的股骨顺转子间骨折的患者,结合术后尖顶距值(TAD值)研究股骨距结构对骨折术后稳定性的影响。方法回顾分析股骨转子间骨折(AO分型A1/A2型)并行股骨近端髓内钉内固定术的85例患者资料,测量并记载骨折的分型、股骨距的完整性、颈干角、股骨颈长度及股骨头高度及TAD。对其骨折后初始及骨折愈合后X线片的相关数值变化进行统计分析。结果股骨距结构完整与否对于术后稳定性影响显著;在股骨距不完整组中,TAD值对于术后稳定性影响具有统计学意义。结论股骨距结构完整性对于转子间骨折术后的稳定性至关重要,对于股骨距结构无法得到有效支撑的患者,控制其TAD值可以有效降低术后髋内翻的发生率。

Objective To explore the effect of posteromedial femoral neck and TAD on the healing of fracture and fixation after reposition in patients who suffered from inter-trochanteric fractures with the treatment of proximal femoral nail. Methods Eighty- five patients suffered from intertrochanteric fractures（AO：A1/A2）and received the treatment of proximal femoral nail were enrolled into this study. The fracture types and shape of the posteromedial femoral neck, the length and the neck-shaft angle of the femoral neck, the height of the femoral head after fixation and the tip apex distance（TAD）of the femoral nail were measured and recorded before and after operation and after the bone healed respectively.The statistical analysis was completed by the SPSS 19.0 data software. Results The integrity of posteromedial femoral neck had significant effect on postoperative stability. TAD had significant effect on the postoperative stability when the posteromedial femoral neck was not integrated（P〈0.05）. Conclusion The integrity of the posteromedial femoral neck is determinant to the stability after intertrochanteric fracture surgery. TAD≤2.5 cm can effectively reduce the incidence of coxa vara after surgery for patients without the support of posteromedial femoral neck during the fixation surgery.