长Gamma钉结合Cable环扎治疗股骨转子下粉碎性骨折

Treatment on comminuted subtrochanteric fracture with long Gamma nail and cable cerclage

目的探讨长Gamma钉结合Cable内固定治疗股骨转子下粉碎性骨折的手术方法和临床疗效。方法回顾性分析2010年8月-2013年7月共收治股骨转子下粉碎性骨折23例,其中男性18例,女性5例,平均年龄41.6岁。术前按Seinsheimer分类：IIIA型12例,IIIB型3例,IV型6例,V型2例。手术均采用牵引床初步复位,骨折端有限切开后点式复位钳钳夹或环抱,透视下复位满意后用Zimmer公司Cable13根环扎固定,最后经大转子打入Stryker公司长Gamma钉。部分严重粉碎性骨折,牵引后骨折块间分离仍明显,可先打入长Gamma钉,然后用多根cable环扎将碎骨块围绕主钉复位固定。临床疗效评定采用Harris髋关节功能评分标准。结果 5例失访,其余18例患者术后随访11-24个月,均未发生切口感染、骨折不愈合或内固定松动断裂,骨折愈合时间平均5.1个月。Harris髋关节功能评分：优良率为94.4%。结论股骨转子下粉碎性骨折,可采用近端撬拨维持或远端控制牵引来初步复位,进一步切开复位并用Cable环扎固定。骨块间的接触,尤其是内侧皮质的接触和支撑非常重要,严重的粉碎性骨折,可以在髓内钉插入后再用Cable复位固定。结合微创理念和相关的器械,长Gamma钉结合Cable内固定治疗股骨转子下粉碎性骨折,可望获得良好的临床疗效。

Objective To investigate the clinical efficacy and discuss the surgical techniques on the treatment of comminuted subtrochanteric fractures with long Gamma nail and cable cerclage.Methods 23 patients of comminuted subtrochanteric fractures were analyzed retrospectively from Aug 2010 to Jul 2013.There were 18 males and 5 females,with a mean age of 41.6 years.According to the Seinsheimer classification,12 cases were of type IIIA,3 cases of type IIIB,6 cases of type IV,and 2 cases of type V.During the operation,generally after clamp assisted reduction,the fragments were kept together with Cable cerclage,and the fracture was fixed with long Gamma nail.But for severe communited fracture,long Gamma nailing might be performed firstly,then the fragments could be pushed together around the nail by Cable cerclage tightening.The outcome was elevated with Harris score.Results 18 cases were followed up for 11 to 24 months,without any non-union and superior or deep infection on the incision,without any loose or breakage of internal fixation device.The clinical union period was 5.1 months on average.According to Harris score,there was 94.4% with excellent and good outcome.Conclusion Treatment of comminuted subtrochanteric fracture with long Gamma nail and cable cerclage will resulted in good outcome.For severe communited fractures,different sequence of reduction performance is suggested on the operation.