斯氏针辅助复位在股骨近端防旋髓内钉固定治疗不稳定型股骨转子间骨折中的应用

Steimnenn pins used to assist reduction in treatment of unstable intertrochanteric fractures with proximal femoral nail antirotation

目的探讨斯氏针辅助复位在股骨近端防旋髓内钉（PFNA）固定治疗不稳定型股骨转子间骨折中的应用效果。方法回顾性分析2010年2月至2013年6月期间收治的38例股骨转子间骨折患者资料。男23例，女15例；年龄为32-69岁；骨折Evans-Jensen分型：Ⅲ型18例，Ⅳ型13例，Ⅴ型7例。根据术中是否采用斯氏针辅助复位分为2组（n=19）：A组患者采用斯氏针辅助牵引床复位PFNA固定，B组患者采用单纯牵引床牵引复位PFNA固定。比较两组患者的骨折复位质量、手术时间、术中出血量、骨折愈合时间及术后1年髋关节Harris评分等。结果术后按照Baumgaertner等改良的方法评定骨折复位质量：A组良好15例，可4例；B组良好9例，可8例，差2例，差异有统计学意义（P〈0．05）。A组患者的手术时间[（50．7±11．9）min]显著短于B组患者[（63．4±15．1）min]，术后1年髋关节Harris评分[（89．4±4．4）分]显著高于B组患者[（79．6±6．4）分]，差异均有统计学意义（P〈0．05）；而两组患者的术中出血量、随访时间及骨折愈合时间比较差异均无统计学意义（P〉0．05）。无一例患者出现再骨折、骨折延迟愈合或不愈合、股骨头缺血性坏死等并发症。结论与单纯牵引床牵引复位PFNA固定治疗不稳定型股骨转子间骨折相比，斯氏针辅助复位技术具有创伤小、操作简单、复位效果理想等优点，疗效更好。

Objective To evaluate application of Steinmenn pins to assist reduction in the treatment of unstable intertrochanteric fractures with proximal femoral nail antirotation（PFNA）. Methods From February 2010 to June 2013, 38 unstable intertrochanteric fractures were treated by us. There were 23 men and 15 women, aged from 32 to 69 years. By Evans-Jensen classification, 18 cases were type Ⅲ, 13 type Ⅳ and 7 type Ⅴ. They were divided into 2 groups （ n = 19） . Group A received reduction on a traction bed as- sisted by Steinmenn pins plus PFNA fixation while group B received reduction only on a traction bed plus PFNA fixation. The 2 groups were compared in terms of fracture reduction, operation time, intro-operative blood loss, fracture healing time, and Harris scores one year postoperation. Results According to the evaluation system modified by Baumgaetner et al., the postoperative quality of fracture reduction was fine in 15 cases and fair in 4 in group A while it was fine in 9 cases, fair in 8 and poor in 2 in group B, showing a significant difference between the 2 groups （ P 〈 0. 05）. The operation time in group A （50. 7 ± 11.9 rain） was significantly shorter than in group B （63.4 ± 15.1 rain）, and the hip joint Harris score （89.4 ±4. 4） oneyear after operation for group A was significantly higher than that for group B （79.6 ±6. 4） （ P 〈 0. 05）. There were no significant differences between the 2 groups regarding intraoperative blood loss, fracture heeling time and follow-up time （ P 〉 0.05）. No cases of refracture, delayed union, nonunion, or avascular necrosis of the femoral head were reported. Cortelusion In the treatment of unstable intertrochanteric fractures, compared with reduction only on a traction bed plus PFNA fixation, application of Stcinmenn pins to assist reduction on a traction bed plus PFNA fixation may lead to better curative efficacy due to its limited invasion, simplicity and beneficial assistance in reduction.