股骨转子间骨折外侧壁的临床意义及其损伤的内固定治疗

Clinical significance of external wall of femoral intertrochanteric fracture and the treatment of internal fixation

背景:外侧壁概念作为近几年兴起的热点领域,对治疗股骨转子间骨折有很大的指导意义。目的:综述外侧壁的定义、范围、厚度及其在股骨转子间骨折手术治疗过程中发挥的重要作用。方法:检索万方、CNKI、PubMed、Web of Science等数据库,检索词为"股骨转子间骨折,外侧壁,骨折固定术"和"intertrochanteric fracture,fracture fixation,lateral wall"。将检索到的文献进行整理并分析总结。结果与结论:①梳理了外侧壁的定义、范围、厚度的测量方法及其临床意义;②总结了基于外侧壁股骨转子间骨折的分类标准;③治疗上,列举了髓外固定、髓内固定、人工关节置换和其他治疗方式共4种治疗方式,并分析了术中术后外侧壁骨折的原因和治疗方法;④结果表明,外侧壁的完整性直接影响内固定的稳定性,甚至影响内固定的成功,完整的外侧壁可以阻止股骨远端内移及头钉退出,预防髋关节内翻畸形。临床医师应该借助详细的影像学检查,分析骨折类型,综合考虑各项因素,选择合适的修复方式。

BACKGROUND:The concept of the lateral wall as a hot area has emerged in recent years,and has great guiding significance for the treatment of intertrochanteric fractures.OBJECTIVE:To review the definition,scope,thickness of the lateral wall and its important role in the surgical treatment of intertrochanteric fractures.METHODS:The authors searched Wanfang,CNKI,PubMed,and Web of Science.The search terms were"intertrochanteric fracture,lateral wall,fracture fixation"in Chinese and English.The retrieved documents were sorted,analyzed and summarized.RESULTS AND CONCLUSION:(1)The definition,scope,thickness and measurement method of the lateral wall and its clinical significance were sorted out.(2)Classification criteria based on lateral intertrochanteric fractures of the femur were summarized.(3)In terms of treatment,four kinds of treatment methods:extramedullary fixation,intramedullary fixation,artificial joint replacement and other treatment methods were listed.Causes and treatment of fracture of lateral wall during and after operation were analyzed.(4)The results showed that the integrity of the lateral wall directly affected the stability of the internal fixation,even the success of the internal fixation.The complete lateral wall can prevent the distal femur from moving inward and the head pin from withdrawing,and prevent the coxa varus deformity.Clinicians should make use of detailed imaging examination,analyze fracture types,comprehensively consider various factors,and select appropriate repair methods.