有限切开微创工具辅助复位髓内固定治疗闭合复位困难的老年股骨转子间骨折

Reduction with Limited Opening Assisted by Minimally Invasive Tools and Intramedullary Fixation in the Treatment of Intertrochanteric Fracture with Difficulty for Close Reduction in the Elderly

目的评估有限切开、微创复位工具辅助复位并股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)内固定治疗难以闭合复位的老年股骨转子间骨折的临床效果以及手术技巧。方法回顾性分析2014年7月—2015年12月期间采用该方法手术的23例老年股骨转子间骨折患者。分析患者的年龄、性别、骨折分型、手术时间、术中出血、复位质量、骨折愈合时间以及并发症等,特别是骨折复位丢失和不愈合。结果根据股骨转子间骨折的AO/ASIF分型标准,A1.3型3例,A2.2型8例,A2.3型12例。平均手术时间(47.2±5.5)min(42~61 min),平均术中出血(56.4±7.6)m L(45~70 m L),所有患者在随访期内达到骨折愈合,平均愈合时间(14.5±1.7)周(12~17周)。术后X光显示21例颈干角在正常范围,2例出现轻度髋内翻。所有患者复位后骨折端移位<3 mm,顶尖距均小于25 mm。1例患者术后出现下肢长度偏差超过1 cm,2例患者出现下肢远端旋转较对侧偏差超过15°。结论有限切开、微创复位工具辅助复位PFNA内固定的方法治疗闭合复位困难的老年股骨转子间骨折,骨折复位质量高,创伤小,安全可行。

Objective To evaluate the clinical effect and surgical technique of reduction with limited opening assisted by minimally invasive tools and intramedullary fixation with proximal femoral nail anti-rotation （PFNA） in the treatment of intertrochanteric fracture with difficulty for close reduction in the elderly. Methods A retrospective analysis was made to clinical data of 23 elderly patients with intertrochanteric fracture during the period from July, 2014 to Dec., 2015, including the age, sex, fracture type, operation time length, bleeding in operation, the quality of fixation, the healing time of fracture and the occurrence of complications, more attention was paid to the second loss of reduction and nonunion. Results According to the AO classification system for intertrochanteric fractures, there were 3 patints of A1.3 type, 8 patients of A2.2 type and 12 patients of A2.3 type; the average operation time length was （47.2±5.5） min, from 42 to 61 min; the average bleeding in operation wasw （56.4 ±7.6） mL, from 45 mL to 70 mL; the fractures of all the patients healed within the follow-up with the average healing time of （14.5± 1.7） weeks, from 12 weeks to 17 weeks; postoperative X-ray examination showed that the collodiaphysial angles in 21 patients were normal while 2 patients had slight coxa vara; the fracture displacement after reduction in all the patients were 〈3 mm, TAD 〈25 mm; lower limb length deviation 〉 1 cm was found in 1 patient and limb rotation 〉 15° in 2 patients. Conclusions It is of high quality of fracture reduction, smaller wound and safety to treat inter-trochanteric fracture with difficulty for close reduction in the elderly with reduction with limited opening assisted by minimally invasive tools and intramedullary fixation with proximal femoral nail anti-rotation （PFNA）.