整复后内侧壁骨折并空心螺钉固定在股骨转子间骨折合并后内侧壁骨折老年患者中的应用效果

Application efficacy of posteromedial fracture reduction and hollow screw fixation in elderly patients with femoral intertrochanteric fracture and posteromedial fracture

目的观察整复后内侧壁骨折并空心螺钉固定在股骨转子间骨折合并后内侧壁骨折老年患者中的应用效果。方法 42例股骨转子间骨折合并后内侧壁骨折老年患者均采用股骨近端防旋髓内钉(PFNA)固定术治疗骨折后,整复股骨后内侧壁骨折块并用空心螺钉固定。根据术后随访X线片及Harris评分进行疗效评价。结果 42例患者中40例顺利完成PFNA联合空心螺钉固定术治疗,成功率为95. 2%(40/42)。手术时间为(73. 5±15. 1) min,术中出血(144. 2±40. 3) ml,骨折愈合时间为(14. 3±3. 2)周。术后1个月时骨折复位效果好38例(95. 0%),可1例(2. 5%),差1例(2. 5%)。术后1～3个月内发生髋内翻3例(7. 5%),未发现螺旋刀片从股骨头、颈切出病例;术后有4例患者出现不同程度骨折块掀起移位。术后1个月时,患者患侧与健侧股骨颈干角比较差异无统计学意义(P>0. 05),而患侧髋关节活动度及Harris评分均差于或低于健侧(均P <0. 05)。术后6个月时,患者患侧与健侧股骨颈干角、髋关节前屈及外展活动度、Harris评分比较,差异均无统计学意义(均P> 0. 05),而患侧髋关节内收、后伸活动度均差于健侧(均P <0. 05)。结论转子间骨折合并后内侧壁骨折老年患者采用PFNA固定治疗转子间骨折后,整复股骨后内侧壁骨折块并用空心螺钉固定,可有效避免术后髋内翻畸形发生,疗效确切,术后并发症较少。

Objective To observe the application efficacy of posteromedial fracture reduction and hollow screw fixation in elderly patients with femoral intertrochanteric fracture and posteromedial fracture.Methods Forty-two elderly patients with femoral intertrochanteric fracture combined with posteromedial fracture underwent fixation using proximal femoral anti-rotation nail(PFNA) for fracture,then reconstruction of posteromedial fracture fragments and fixation by with hollow screw were conducted.The efficacy was evaluated according to X-ray imaging and Harris score during postoperative follow-up.Results Among 42 patients,fixation using PFNA and hollow screw was successfully completed in 40 patients,and the success rate was 95.2%(40/42).The operation time was(73.5±15.1)min,blood loss was(144.2±40.3)ml,and duration for fracture healing was(14.3±3.2)weeks.One month after of operation,the efficacy of fracture reduction was assessed as excellent,good and poor in 38 cases(95.0%),1 case(2.5%) and 1 case(2.5%),respectively.Coxa adducta was found in 3 cases(7.5%),with no spiral blade penetrating through femoral head or neck found within postoperative 1-3 months,and displacement of fracture fragments in various degrees was found in 4 cases after operation.One month after operation,no significant difference in the angle between femoral neck and shaft of femur was observed between affected and healthy sides in the patients( P >0.05),but the mobility and Harris score of the affected hip joint were worse/lower than those of the healthy side(all P <0.05).Six months after operation,there were no significant differences in the angle between femoral neck and shaft of femur,anteflexion or abduction of hip joint,or Harris score between the affected and the healthy sides(all P >0.05),but adduction and extension of affected hip joint were worse than those of healthy side(all P <0.05).Conclusion After fixation using PFNA for intertrochanteric fracture,reconstruction of the posteromedial fracture fragments and fixation by with hollow screw can effectively avoid postoperative deformity of coxa adducta with a definite efficacy and less complications in elderly patients with intertrochanteric fractures and posteromedial fractures.