边缘克氏针辅助髓内钉固定同侧股骨粗隆间和颈骨折

Marginal Kirschner wires assisted proximal intramedullary nailing for ipsilateral femoral intertrochanter and neck fractures

[目的]介绍边缘克氏针辅助股骨近端髓内钉固定股骨粗隆间伴同侧股骨颈骨折的手术技术与初步临床疗效。[方法] 2016年7月~2018年6月,采用边缘克氏针临时固定辅助的股骨近端髓内钉(Intertan)固定治疗股骨粗隆间伴同侧股骨颈骨折11例患者。所有患者均行闭合牵引复位,其中2例加行有限切开复位。术中确保二处骨折复位均满意后,采用多枚经皮克氏针于股骨近端皮质骨边缘行临时固定,确保骨折复位稳定及不影响髓内钉插入,随后按常规操作完成股骨近端髓内钉内固定,确保骨折获得可靠内固定后取出克氏针。[结果]所有患者均顺利完成手术,置入内固定过程中未出现复位丢失,骨折端均复位良好,达到内侧阳性支撑;手术时间(70.00±8.06) min;出血量(113.64±42.25) ml。所有患者均未出现伤口感染、神经血管损伤等软组织并发症。所有患者均获随访12个月以上,末次随访时,Harris髋关节功能评分为(85.91±6.09)分。影像显示,所有患者骨折均顺利愈合,愈合时间(22.45±3.53)周,内固定位置良好,无松动或断裂,无骨折复位丢失、畸形愈合。[结论]股骨近端髓内钉是治疗股骨粗隆间伴同侧股骨颈骨折的有效方法,而术中股骨近端皮质骨边缘克氏针的临时固定能确保髓内固定的有效完成,是手术取得满意疗效的关键步骤。

[Objective] To introduce the surgical technique and preliminary clinical results of marginal Kirschner wires assisted femoral proximal intramedullary nailing for ipsilateral femoral intertrochanter and neck fractures. [Methods] From July 2016 to June 2018, 11 patients received marginal Kirschner wires assisted femoral proximal intermedullary nailing(Intertan) for ipsilateral femoral intertrochanteric and neck fractures. All the patients underwent closed reduction under traction, except 2 of them who had limited open reduction added.After satisfactory reduction of the two fractures achieved during the operation, multiple percutaneous Kirschner wires were placed for temporary fixation on the cortical edge of the proximal femur to ensure stable reduction of the fracture without affecting the insertion of the intramedullary nail. Then, the femoral proximal intermedullary nail was inserted in conventional manner. As reliable internal fixation of the fractures obtained with the intramedullary nail, the marginal Kirschner wires for temporary fixation were removed. [Results] All patients had fracture reduction and fixation completed successfully, with no loss of fracture reduction in positive medial support during the process of intermedullary nailing. The operation lasted for an average of(70.00±8.06) min with blood loss of(113.64±42.25) ml. No soft tissue complications, such as wound infection and neurovascular injury, occurred in anyone of the patients. All patients were followed up for more than 12 months. At the latest follow-up, Harris score for hip function was of(85.91±6.09). With regard to imaging evaluation, fracture healing achieved in all patients in an average of(22.45±3.53) weeks, additionally, the implants remained in proper position without loosening or breakage, and no fracture reduction loss or malunion was noted in any patient. [Conclusion] The marginal Kirschner wires assisted femoral proximal intramedullary nailing is an effective method for the treatment of ipsilateral femoral intertrochanter and neck fractures. The temporary fixation of the Kirschner wires on the edge of the cortical bone does ensure the effective completion of intramedullary nailing, which is the key step to achieve satisfactory results.