髓内钉固定治疗多节段股骨骨折的疗效分析

Efficacy of intramedullary nailing in the treatment of multi-segment femoral fractures

目的探讨髓内钉治疗多节段股骨骨折的方案及其预后。方法回顾性分析2017年8月—2019年6月三峡大学附属仁和医院骨科收治的10例多节段股骨骨折患者临床资料,男性8例,女性2例;年龄35~75岁,平均48.5岁。致伤原因:道路交通伤6例,高处坠落伤4例。骨折分型:股骨转子间骨折合并股骨干骨折(AO分型31A1.3合并32B2)3例、股骨颈骨折合并股骨干骨折(31A2.2合并32B2)2例、多节段股骨干骨折(32C)4例、股骨远端合并股骨干骨折(32A2合并33B2)1例。损伤严重度评分(ISS)9~34分,平均21.0分,受伤至手术时间平均9.9d(5~24d)。根据骨折位置及移位程度,行闭合或开放复位、单根髓内钉固定等方案。记录并分析手术时间、术后并发症、骨折愈合情况及愈合时间等。结果随访时间6个月~3年,平均11.0个月,闭合性复位内固定8例,开放切开髓内钉固定2例。术后骨折不愈合1例,予以加行侧方钢板固定并植骨后顺利愈合,术后4个月左右获得愈合。平均手术时间180.0min(100~245min),术中失血量605.0mL(200~1300mL),总输血量平均5.75U(0~13U)。结论单一髓内钉固定或髓内钉固定为主联合其他方式固定治疗多节段股骨骨折固定牢固有效,需要灵活应用多种手术技术和策略,疗效良好。

Objective To explore the scheme and prognosis of intramedullary nailing in the treatment of multi-segment femoral fractures.Methods The clinical data of 10 patients with multi-segment femoral fractures in our hospital from Aug.2017 to Jun.2019 were analyzed retrospectively.There were 8 males and 2 females,aged 35-75 years,with an average of 48.5 years.Causes of injury:6 cases were injured by traffic accident and 4 cases were injured by falling from height.Classification of fractures:intertrochanteric fracture with femoral shaft fracture in 3 cases(AO31A1.3 with 32B2),femoral neck fracture with femoral shaft fracture in 2 cases(31A22 with 32B2),multi-level femoral shaft fracture in 4 cases(32C),and distal femur with femoral shaft fracture in 1 case(32A2 with 33B2).The mean injury severity score(ISS)was 21.0(9-34)points.And the average time from injury to operation was 9.9 days(5-24 days).According to the fracture position and displacement degree,closed or open reduction,single intramedullary nail fixation,and other fixation schemes were performed.The operation time,postoperative complications,fracture healing rate and time were analyzed.Results The follow-up time was 6 months to 3 years,with an average of 11.0 months.Closed reduction and internal fixation were performed in 8 cases,open incision and intramedullary nailing in 2 cases.Postoperative fracture nonunion occured in 1 case,which was successfully healed after lateral plate fixation added and bone grafting.Healing was achieved about 4 months after the operation.The average operation time was 180.0 minutes(100-245 minutes),the intraoperative blood loss was 605.0 mL(200-1300 mL),and the average total blood transfusion volume was 5.75 U(0-13 U).Conclusion Single intramedullary fixation or intramedullary fixation combined with other methods to treat multi-segment femoral fractures is firm and effective,requiring flexible application of various surgical techniques and strategies,and the curative effect is good.