AO/A2型股骨粗隆间骨折内固定选择的影像学回顾性分析

Retrospective analysis of AO/A type 2 intertrochanteric fractures treated by internal fixation

目的探讨A0／A2型股骨粗隆间骨折手术内固定方法的选择。方法回顾性分析自2011-10--2014-05诊治并行内固定治疗的106例A2型股骨粗隆间骨折的临床资料，其中A2．1型29例，A2．2型45例，A2-3型32例。结果本组106例均得随访7。34个月，平均21个月。所有患者均获得骨性愈合，无一例需再手术行内固定翻修治疗。部分采用动力髋螺钉（DHS）或股骨近端锁定加压板内固定治疗的患者出现不同程度髋内翻畸形及股骨头内螺钉退出。结论对于A2型股骨粗隆间骨折．DHS内固定仍是首选的治疗方法。但在A2．2、A2．3型股骨粗隆间骨折，特别是A2．3型骨折，使用DHS或股骨近端锁定加压板等髓外固定时要特别注意保持股骨近端外侧壁的完整性，避免出现术中或术后医源性外侧壁骨折。当患者存在有骨质疏松、股骨外侧壁骨量明显减少、骨折线向小粗隆远端延伸较长时，宜选用Gamma3或PF-NA等髓内固定系统，从而避免因股骨外侧壁的破坏而出现髋内翻和退钉，甚至内固定的失败。

Objective To investigate the internal fixation methods of the A0/A2 intertrochanteric fractures. Methods The X-ray imaging data of 106 intertrochanteric fracture patients treated by internal fixation from October 2011 to May 2014 in our hospital were retrospectively analyzed. The fracture type was all A0/A2 （type A2.1 29 cases, type A2.2 45 cases, A2.3 32 cases）. Results One hundred and six patients were followed up for 7-34 months, average 21 months. All of the patients reached osseous healing, no one needed surgery again. Some of patients fixed with DHS or proximal femoral locking compress plate had different degree of neck stem angle deformity or within the femoral head screw back. Conclusion For A2 intertrochanteric fracture, DHS internal fixation is the preferred treatment. But in type A2.2, A2.3 intertrochanteric fractures, especially the type A2.3 fractures, using DHS or proximal femoral locking plate for fixation special attention should be paid to maintain the integrity of the lateral femoral proximal wall, avoiding intra-operative or postoperative iatrogenic lateral femoral proximal wall fracture. If patients have osteoporosis, lateral femoral wall bone is decreased significantly, fracture line extends longer to lesser trochanter distally, appropriate choice is Gamma 3 or PFNA intramedullary fixation system, to avoid the neck stem angle deformity and screw back due to the destruction of the lateral femoral wall.