钢丝环扎强化固定辅助髓内钉治疗老年粗隆间骨折的临床疗效

The Study of Clinical Efficacy of Wire Cerclage Reinforcement Fixation Combined with Intramedullary Nail on the Treatment of Intertrochanteric Fractures in the Elderly Patients

目的:分析钢丝环扎强化固定辅助髓内钉治疗AO/OTA A3.3型老年粗隆间骨折病例的临床疗效。方法:回顾性分析2017年1月至2022年1月收治的40例A3.3型老年粗隆间骨折病例资料,均采用髓内钉固定辅助钢丝环扎强化固定治疗,术后分析骨折复位情况、愈合时间、日常生活情况和髋关节功能。结果:40例病例除3例失访外其余均获随访,随访时间为(11.5±1.6)个月(9~15个月)。术后即刻股骨外侧壁倾斜角为4.5°±0.8°(3.2°~6.0°)。1例术后出现髋内翻畸形,1例术后出现螺钉切割,1例出现手术切口浅表感染,其余病例骨折复位愈合良好,骨折愈合平均时间为(7.3±1.8)个月(5~12个月)。末次随访Harris髋关节评分(Harris Hip Score,HHS)平均为(86.8±3.2)分(82~91分),优22例,良14例,可4例。结论:钢丝环扎强化固定辅助髓内钉治疗不稳定AO/OTA A3.3型老年粗隆间骨折,固定可靠,术后并发症少,是一种有效的方法。

Objective:To analyze the clinical efficacy of wire cerclage reinforcement fixation combined with intramedullary nail on the treatment of AO/OTA type A3.3 intertrochanteric fractures in the elderly patients.Methods:A retrospective analysis was performed on 40 elderly patients with type A3.3 intertrochanteric fractures from January 2017 to January 2022.All patients were treated with intramedullary nail fixation assisted by wire cerclage for strengthening fixation.The fracture reduction,healing time,daily life and hip joint function were analyzed after operation.Results:All patients were followed up for(11.5±1.6)months(9-15 months)except 3 patients who were lost to follow-up.The Lateral femoral wall angle was 4.5°±0.8°(3.2°-6.0°)immediately after operation.Coxa vara occurred in 1 case,screw cutting occurred in 1 case,and superficial infection of surgical incision occurred in 1 case.The rest of the patients had good fracture reduction and healing,and the average time of fracture healing was(7.3±1.8)months(5-12 months).The average Harris hip score(HHS)was(86.8±3.2)points(range 82-91 points)at the last follow-up.The results were excellent in 22 cases,good in 14 and fair in 4 cases.Conclusion:It is an effective method for the treatment of unstable AO/OTA type A3.3 intertrochanteric fractures in the elderly patients using wire cerclage reinforcement fixation combined with intramedullary nail,with reliable fixation and fewer postoperative complications.