难复性股骨转子骨折术中的一种复位技巧

A reduction technique for the treatment of refractory femoral trochanteric fracture

目的 :探讨骨膜剥离器经螺旋刀片切口联合侧向瞄准器支架撬拨法治疗伴有骨折近端上翘的难复性股骨转子骨折的效果、复位技巧和原理。方法:自2015年3月至2017年10月以骨膜剥离器经螺旋刀片切口联合侧向瞄准器支架撬拨法治疗伴有骨折近端上翘的难复性股骨转子骨折的患者26例,男9例,女17例;年龄63~85(76.3±8.4)岁;根据AO/OTA分型,A1.3型5例,A2.1型6例,A2.2型7例,A2.3型8例;均为闭合性骨折。观察记录手术中出血量、骨折愈合时间,进行髋关节功能Harris评分。结果:26例均获随访,时间7~26(17.4±4.7)个月;手术中出血量50~100(80.0±9.6)ml。骨折愈合时间9~15(12.4±3.5)周。末次随访Harris评价结果 :优23例,良2例,可1例。结论:运用骨膜剥离器经螺旋刀片切口联合侧向瞄准器支架撬拨法在治疗难复性股骨转子骨折中,复位效果确切,手术时明显缩短,不用辅助小切口,临床效果好,复位技巧简便实用。

Objective： To explore the effect of periosteal stripper through spiral blade incision combined with lateral sight bracket prying method in the treatment of irreducible femoral trochanteric fractures with proximal upwarping of fracture.Methods： From March 2015 to October 2017,26 patients with refractory femoral trochanteric fractures with proximal upwarp of fracture were treated by periosteal dissection through a spiral blade incision and lateral sight bracket prying,included 9 males and 17 females with an average age of （76.3±8.4） years old ranged from 63 to 85 years old. According to OA/OTA classification,5 cases were type A1.3 fracture,6 cases were A2.1,7 cases were A2.2,8 cases were A2.3. All cases were closed fractures. The amount of bleeding during operation and the time of fracture healing were observed and recorded. The Harris score of the hip joint function was performed.Results： All cases were followed up from 7 to 26 months with an average of （17.4±4.7） months. Bone union time was from 9 to 15 months with an average of（12.4±3.5）weeks according to X-rays. At the final follow-up,Harris scores were 86 to 93 points with an average of （85.8±5.6） points,23 cases were classified as excellent,2 as good,and 1 as fair.Conclusion： Using periosteum stripper through spiral blade incision combined lateral sight bracket prying for the treatment of irreducible femoral trochanteric fracture,the reduction effect is accurate,the operation time is shortened obviously,no auxiliary small incision is needed,the clinical effect is good,the reduction technique is simple and practical.