非解剖复位治疗股骨转子间骨折的临床观察

Clinical Observation of Non Anatomical Reduction in the Treatment of Intertrochanteric Fracture

目的:介绍股骨转子间骨折非解剖复位"阳性支撑"的概念,并探讨其在临床实践中的应用价值。方法:回顾性分析2015年1月至2017年3月间,110例股骨转子间骨折的老年患者均使用动力髋螺钉(DHS)固定,根据术后正位X线片近端骨折内侧皮质与远端骨折内侧皮质的对位关系分成三组,即阳性支撑(75例)、解剖复位(23例)、阴性支撑(12例)。分别比较术前合并症、性别比、年龄组成,术中出血量、手术时间、尖顶距及术后颈干角、股骨颈长度、并发症、Harris评分,分析不同组别之间的差异。结果:三组患者术前及术中的性别比例、年龄组成、合并内科疾病、手术时间、术中出血量及TAD值差异无统计学意义(P<0.05)。术后即刻测得的颈干角、股骨颈长度及随访测得的颈干角、股骨颈长度、Harris评分、术后并发症发病率差异有统计学意义(P<0.05),阳性支撑组要优于阴性支撑组。结论:股骨转子间骨折非解剖复位阳性支撑允许骨折端有限滑动,起到二次稳定骨折端的作用,为骨折愈合创造适当的力学环境,能够让患者在早期进行功能锻炼,减少术后并发症,利于术后功能的恢复。

Objective：To introduce the concept of ＂positive support＂ in non-anatomical reduction of intertrochanteric fractures and discusses its application value in clinical practice.Methods：110 elderly cases of intertrochanteric fractures treated with DHS fixation between January 2015 and March 2017 was evaluated retrospectively.According to the relative position between the proximal medial cortex and the distal cortex of the distal fracture,there were three groups：positive support group（75 cases）,anatomical reduction group（23 cases）and negative support group（12 cases）.The differences in preoperative complications,gender,age,weight,operation time,tip-Apex Distance,neck-shaft angle,femoral neck length,complications and Harris score were compared between the three groups.Results：There was no significant difference in sex ratio before and during the operation,age composition,combined disease,operation time,intraoperative bleeding and TAD value between the three groups（P〈0.05）.The neck-shaft angle,femoral neck length,Harris score and postoperative complications rate measured immediately after operation were statistically different with those measured by follow up（P〈0.05）.The positive support group was better than the negative support group.Conclusion：Intertrochanteric fracture with anatomical reduction of non positive support allows limited slipping of fracture,which has the effect of restabilizing the fracture.It creates a suitable mechanical environment for fracture healing,allows patients to perform functional exercises in the early stage,reduces postoperative complications and facilitates the recovery of postoperative function.