髓内钉联合微创环扎与单纯髓内钉固定治疗长斜形股骨转子下骨折的疗效比较

Comparison of intrameduUary nailing combined with minimally invasive eerdage versus simple intramedullary nailing for femoral long oblique subtrochanteric fractures

目的比较微创环扎辅助髓内钉固定与单纯髓内钉固定治疗长斜形股骨转子下骨折的疗效。方法回顾性分析2010年4月至2015年9月采用髓内钉固定治疗的39例长斜形股骨转子下骨折患者资料。其中采用微创环扎辅助髓内钉固定16例（观察组），男11例，女5例；平均年龄为（42．8±13．2）岁。采用单纯髓内钉固定治疗23例（对照组），男17例，女6例；平均年龄为（46．2±10．1）岁。比较两组患者的手术时间、术中出血量、骨折愈合情况、髋关节内翻角度、疼痛视觉模拟评分（VAS）及髋关节Harris评分等。结果39例患者术后获12～30个月（平均15个月）随访。观察组患者的髋内翻角度（2．2°±1．4°）显著小于对照组患者（4．1°±2．2°），术后1、3个月的疼痛VAS评分【（3．43±1．54）、（1．13±1．20）分】显著低于对照组患者【（5．61±1．41）、（3．34±1.82）分】，术后3个月骨折临床愈合率（87．5％，14／16）显著高于对照组患者（47．8％，11／23），差异均有统计学意义（P〈0．05）。但两组患者的手术时间、术中出血量、术后1年髋关节Harris评分结果、术后6个月疼痛VAS评分、术后6、12个月的骨折临床愈合率比较差异均无统计学意义（P〉0．05）。结论微创环扎辅助髓内钉固定与单纯髓内钉固定治疗长斜形股骨转子下骨折均可获得满意疗效，但辅助微创环扎可提高骨折复位率和固定强度，早期可更好地缓解患者疼痛，有利于患者骨折愈合及早期功能锻炼。

Objective To compare intramedullary nailing assisted by minimally invasive cerclage with simple intramedullary nailing in the treatment of femoral long oblique subtrochanteric fractures. Methods From April 2010 to September 2015, our department treated 39 patients with femoral long oblique subtrochanteric fracture. Of them, 16 were treated by cephalomedullary nailing combined with minimally invasive cerclage （observation group of 11 males and 5 females with an average age of 42. 8 ＋ 13.2 years） and 23 by simple cephalomedullary nailing （control group of 17 males and 6 females with an average age of 46.2 ＋ 10. 1 years）. Their operation time, intraoperative blood loss, radiologic results （union time and alignment） and functional results [Visual Analog Scale （VAS） and Harris hip score] were compared between the 2 groups. Results The 39 patients were followed up from 12 to 30 months （average, 15 months） . For the observation group, the varus angle （2. 2° ±1.4°） was significantly smaller than for the control group（4.1°± 2. 2°）, the VAS scores at 1 and 3 months postoperatively （3.43 ±1. 54, 1.13 ± 1.20） were significantly lower than for the control group （5.61 ± 1.41, 3.34± 1.82）, and the clinical union ratio at 3 months postoperatively（87.5%, 14/16） signifi- cantly higher than for the control group （47.8%, 11/23） （P 〈 0. 05）. There were no significant differ- ences between the 2 groups in terms of operation time, intraoperative blood loss, Harris hip score at one year postoperatively, VAS score at 6 months postoperatively, or clinical union ratio at 6 or 12 months postoper- atively（ P 〉 0. 05）. Conclusions Cephalomedullary nailing is effective for the treatment of femoral long oblique subtrochanteric fractures no matter it is assisted by minimally invasive cerclage or not. However, since minimally in- vasive cerclage has the advantage of improving reduction and mechanical stability, combination of minimally invasive cerclage and cephalomedullary nailing may be more advantageous in early pain-relieving and functional recovery.