股骨转子间骨折头髓钉固定术中楔形撑开效应及其预防的研究进展

Progress in research into the wedge effect during cephalomedullary nailing for intertrochanteric fractures

股骨转子间骨折是临床常见骨折,临床首选手术治疗,头髓钉内固定(两个部件分别插入股骨髓腔和股骨头内)手术已成为治疗老年股骨转子间骨折的主流方案。但插入头髓钉的过程中易引起股骨干向外移位和头颈骨块内翻旋转现象,即"楔形撑开效应"。如何预防楔形撑开效应,减少其导致的髋内翻畸形等并发症,目前尚无系统报道。本文从楔形撑开效应的概念、产生机制、影响因素、测量指标、预防方法等方面系统阐述和分析,以期为手术治疗中避免楔形撑开效应的发生提供参考。

Surgical intervention is the first choice treatment for intertrochanteric fractures that are common in clinical practice.Cephalomedullary nailing with two parts inserted respectively into the femoral medullary cavity and femoral head has been the mainstream protocols for the elderly patients with intertrochanteric fracture,but insertion of the cephalomedullary nail may likely lead to the outward displacement of the femoral shaft and the inversion and rotation of the head and neck bone mass,namely the so-called wedge effect.However,few reports have dealt with how to prevent the wedge effect and reduce the complications it may cause such as coxa vara deformity.The present review expounds and analyzes the concept,biomechanical mechanism,influencing factors,measurements,and prevention methods of the wedge effect,hoping to help the surgeons who try to avoid the wedge effect in surgical treatment.