侧卧位外侧切口钢板辅助复位固定联合髓内钉治疗复杂股骨转子下骨折

Lateral decubitus position assisted plate internal fixation through a lateral incision to assist reduction combined with intramedullary nail in treatment of complicated subtrochanteric femoral fracture

目的 探讨侧卧位外侧切口钢板辅助复位固定联合髓内钉治疗复杂股骨转子下骨折的临床效果。方法 回顾分析2017年9月—2020年8月采用侧卧位外侧切口钢板辅助复位固定联合髓内钉治疗的16例复杂股骨转子下骨折(SeinsheimerⅢ~Ⅴ型)患者临床资料。其中男13例,女3例;年龄26~85岁,平均47岁。高能量损伤12例,低能量损伤4例。骨折按Seinsheimer分型:ⅢA型3例,ⅢB型2例,Ⅳ型7例,Ⅴ型4例。受伤至手术时间2~6 d,平均4.7 d。记录患者手术时间、术中失血量、术后引流量、住院时间、手术并发症、骨愈合时间及手术前后健患侧颈干角;采用髋关节Harris评分评价髋关节功能。结果 手术时间90~180 min,平均135.9 min;术中失血量200~400 mL,平均288.8 mL;术后引流量120~220 mL,平均140.0 mL;住院时间12~22 d,平均15.8 d。16例患者均获随访,随访时间9~12个月,平均9.9个月。术后出现1例切口浅表感染,予以抗感染治疗后愈合;无下肢深静脉血栓形成、髋内翻畸形、再次骨折、断钉等并发症发生。所有骨折均顺利愈合,愈合时间12~20周,平均17.5周。术后6个月Harris评分为87~96分,平均91.5分;优11例、良5例,优良率达100%。术前患侧和健侧颈干角分别为(124.0±5.7)°和(132.0±2.1)°,差异有统计学意义(t=–7.376,P=0.001);末次随访时患侧颈干角为(129.0±3.2)°,较术前患侧显著改善(t=–6.175,P=0.002),且与健侧比较差异无统计学意义(t=–2.648,P=0.181)。结论 侧卧位外侧切口钢板辅助复位固定联合髓内钉治疗复杂股骨转子下骨折疗效肯定,利用钢板复位骨折有利于维持股骨转子下力线的复位,切口扩大利于髓内钉的准确植入,不影响骨折愈合。

Objective To investigate the effectiveness of lateral decubitus position assisted plate internal fixation through a lateral incision to assist reduction combined with intramedullary nail in the treatment of complicated subtrochanteric femoral fracture. Methods The clinical data of 16 patients with complicated subtrochanteric femoral fractures(Seinsheimer type Ⅲ-Ⅴ) treated with lateral decubitus position assisted plate internal fixation through a lateral incision to assist reduction combined with intramedullary nail between September 2017 and August 2020 were retrospectively analyzed. There were 13 males and 3 females with an average age of 47 years(range, 26-85 years). There were 12 cases of high-energy injury and 4 cases of low-energy injury. According to Seinsheimer classification, there were3 cases of type ⅢA, 2 cases of type ⅢB, 7 cases of type Ⅳ, and 4 cases of type Ⅴ. The time from injury to operation ranged from 2 to 6 days, with an average of 4.7 days. The operation time, intraoperative blood loss, postoperative drainage volume, hospitalization stay, surgical complications, fracture healing time, and collodiaphyseal angle of the affected and healthy sides before and after operation were recorded. Hip fracture Harris score was used to evaluate hip function.Results The operation time was 90-180 minutes(mean, 135.9 minutes), the intraoperative blood loss was 200-400 mL(mean, 288.8 mL), the postoperative drainage volume was 120-220 mL(mean, 140.0 mL), and the hospitalization stay was12-22 days(mean, 15.8 days). All the 16 patients were followed up 9-12 months(mean, 9.9 months). There was 1 case of incision superficial infection after operation, which healed after anti-infection treatment;no complication such as deep venous thrombosis of lower limbs, coxa vara deformity, re-fracture, or broken nails occurred. All the fractures healed successfully, the healing time ranged from 12 to 20 weeks, with an average of 17.5 weeks. At 6 months after operation, the Harris score was 87-96, with an average of 91.5;the results were excellent in 11 cases and good in 5 cases, with the excellent and good rate of 100%. The collodiaphyseal angle of the affected side was(124.0±5.7)°, while that of the healthy side was(132.0±2.1)°, showing significant difference between the two sides(t=–7.376, P=0.001). At last follow-up, the collodiaphyseal angle of the affected side was(129.0±3.2)°, which significantly improved when compared with that before operation(t=–6.175, P=0.002), and there was no significant difference between the affected side and the healthy side(t=–2.648, P=0.181). Conclusion Lateral decubitus position assisted plate internal fixation through a lateral incision to assist reduction combined with intramedullary nail is a reliable internal fixation method for the treatment of complicated subtrochanteric femoral fractures. The use of plate reduction is conducive to maintaining the force line of the femoral trochanter. The enlargement of the incision is conducive to the accurate implantation of intramedullary nails without affecting fracture healing.