AO分型A2型难复性粗隆间骨折的影像学特点分析

Analysis of imaging features of AO type A2 refractory intertrochanteric fractures

目的探讨AO分型A2型难复性粗隆间骨折的影像学特点及干预措施。方法回顾性分析78例难复性AO分型A2型粗隆间骨折患者的临床资料,分析术中闭合牵引前后影像学变化,统计手术时间、术中出血量、骨折愈合时间、感染情况、并发症发生情况及髋关节功能。结果以牵引后不同影像学表现为基础,根据术前CT检查分为旋后1型、旋后2型、旋前1型、旋前2型。旋后1型牵引后正位出现髋内翻不能纠正;旋后2型侧位出现近端向后移位;旋前1型牵引后出现正位分离移位;旋前2型出现近端侧位向前方移位。手术时间为35〜75 min,平均手术时间为(50±15)min;术中出血量为50〜300 ml,平均术中出血量为(150±75)ml;随访时间为6〜18个月,平均随访时间为(10.0±2.7)个月;骨折愈合时间为8〜16周;平均骨折愈合时间为(12.0±2.5)周;所有患者未出现感染情况;术后并发症发生率为10.26%(8/78),其中发生3例轻度髋内翻畸形,经治疗后愈合;3例术后出现精神谵妄,经过治疗后好转;2例发生下肢深静脉血栓,经治疗后好转。采用Harris评定髋关节功能,其中优62例,良9例,差7例。结论根据AO分型A2型难复性粗隆间骨折的影像学特点,针对性应用不同复位技术进行复位后置钉,避免切开复位导致的创伤并避免可能出现的并发症,从而更好的提高难复性粗隆间骨折的治疗效果。

Objective To discuss the imaging features and intervention measures of AO type A2 refractory intertrochanteric fractures.Methods The clinical data of 78 patients with AO type A2 refractory intertrochanteric fractures was retrospectively analyzed.The imaging changes before and after closed traction were analyzed,and the operation time,intraoperative blood loss,fracture healing time,infection,complications and hip joint function were counted.Results On the basis of different imaging findings after traction,it can be divided into supination type 1,supination type 2,pronation type 1 and pronation type 2 according to preoperative CT examination.In supination type 1,coxa vara could not be corrected in the anteroposterior position;in supination type 2,proximal displacement occurred in the lateral position;in pronation type 1,separation displacement occurred in the anteroposterior position;in pronation type 2,proximal displacement occurred in the lateral position.The operative time ranged from 35 to 75 min,with a mean operative time of(50±15)min;the intraoperative hlood loss ranged from 50 to 300 ml,with a mean intraoperative blood loss of(150±75)ml;the follow-up time ranged from 6 to 18 months,with a mean follow-up time of(10.0±2.7)months;the fracture healing time ranged from 8 to 16 weeks,with a mean fracture healing time of(12.0±2.5)weeks.There was no infection in all patients;the postoperative complication rates was 10.26%(8/78),including 3 cases of mild hip inversion deformity,which healed after treatment;3 cases of postoperative delirium,which improved after treatment;2 cases of lower limb deep vein thrombosis,which improved after treatment.The hip function was evaluated by Harris,among which 62 cases were excellent,9 cases were good and 7 cases were poor.Conclusion According to the imaging features of AO type A2 refractory intertrochanteric fracture,different reduction techniques were applied for reduction and post-reduction nail placement to avoid trauma caused by incision and avoid possible complications,so as to better improve the therapeutic effect of refractory intertrochanteric fracture.