长Gamma钉结合有限切开复位钛缆环扎固定治疗ScinsheimerⅢ～Ⅴ型股骨粗隆下骨折

Cable cerclage through a mini-incision approach to assist reduction of comminuted subtrochanteric femoral fractures treated with long Gamma nail

目的探讨长Gamma钉结合有限切开复位钛缆环扎固定治疗ScinsheimerⅢ～Ⅴ型股骨粗隆下骨折的临床疗效和手术技巧。方法 2012年7月至2017年6月治疗ScinsheimerⅢ～Ⅴ型股骨粗隆下骨折共31例,其中,男24例,女7例,平均年龄(46.4±8.7)岁。术前按Scinsheimer分类:ⅢA型11例,ⅢB型9例,Ⅳ型6例,Ⅴ型5例。手术先用牵引床初步复位,然后有限切开,综合采用多种微创方法复位骨折块,钛缆环扎固定骨折块,再自大粗隆顶点顺行插入长Gamma钉进行固定。临床疗效评定采用Harris髋关节功能评分标准及影像学评价。结果患者均获得随访,时间12～24个月。骨折均愈合,骨折愈合时间平均17.6(12～34)周,无感染、内固定物松动断裂、骨不连、肢体短缩、髋内翻、畸形愈合等并发症。末次随访髋关节功能Harris评分结果:优24例,良5例,可2例,优良率为93.5%。结论长Gamma钉结合有限切开复位钛缆环扎固定治疗ScinsheimerⅢ～Ⅴ型股骨粗隆下骨折具有创伤小、内固定牢靠及术后并发症少等优点,值得临床推广。

Objective To investigate the clinical efficacy and surgical techniques of long Gamma nail combined with miniincision approach and cable cerclage fixation in the treatment of Scinsheimer type Ⅲ-Ⅴ subtrochanteric femoral fractures. Methods From July 2012 to June 2017, 31 cases of Scinsheimer type Ⅲ-Ⅴ subtrochanteric femoral fractures were treated, including 24 males and 7 females, with an average age of (46.4±8.7) years. According to Scinsheimer classification before operation, there were 11 cases of type Ⅲ A, 9 cases of type Ⅲ B, 6 cases of type Ⅳ, and 5 cases of type Ⅴ. Firstly, initial reduction was obtained by traction bed, and then a mini-incision approach was used. Several minimally invasive methods were used to reduce the fragment, cable cerclage was used tofix the fragment, and long Gamma nail was inserted anterogradely from the apex of the greater trochanter. The clinical efficacy was assessed by Harris hip joint function score and imaging evaluation. Results All patients were followed up for 12 to 24 months. The average healing time was 17.6 (12 .34) weeks. There were no complications such as infection, loosening and breaking of internal fixator, nonunion, shortening of limbs, coxa vara and malunion. At last follow-up, hip joint function according to Harris score: excellent in 24 cases, good in 5 cases, acceptable in 2 cases, the excellent and good rate was 93.5%. Conclusion The treatment of Scinsheimer type Ⅲ-Ⅴ subtrochanteric femoral fractures with long Gamma nail combined with mini-incision approach and cable cerclage fixation has the advantages of minimally invasive, reliable and less postoperative complications. It is worthy of clinical promotion.