克氏针辅助闭合复位微创防旋股骨近端髓内钉固定治疗股骨逆转子间骨折

Closed Replacement and Minimally Invasive Process of Kirchner Assisted Proximal Femoral Nail Antirotation in Treatment of Reversal Intertrochanteric Fracture

目的:探讨借助克氏针闭合复位防旋股骨近端髓内钉固定治疗股骨逆转子间骨折的手术技巧及临床疗效。方法:2014年6—9月,在术中C臂X线机透视下,采用闭合牵引床牵引、克氏针辅助复位,以股骨近端髓内钉内固定术治疗股骨逆转子间骨折13例,其AO分型为A3.1型5例、A3.3型8例。术后每隔4周复查X线片随访,确定骨性愈合时间,进行Harris评分作出疗效评定,总结术中复位技巧。结果:本组术中通过闭合牵引床牵引、克氏针辅助复位,骨折端均能得到良好复位,手术较为顺利。术后13例患者均获得4~6个月随访,无感染、脂肪栓塞、深静脉血栓形成、骨折不愈合、髋内翻及旋转畸形等并发症发生,无死亡病例。根据Harris标准评分,优9例,良3例,中1例,优良率92.31%。结论:克氏针辅助利于股骨逆转子间骨折的闭合复位,股骨近端髓内钉固定治疗股骨逆转子间骨折、创伤小、易于操作,有利于骨折复位以及保护髓外血运,疗效可靠。

Objective: To investigate the surgical techniques and clinical efficacy of the closed replacement and minimally invasive process of Kirchner assisted proximal femoral nail antirotation in the treatment of reversal intertrochanteric fracture. Methods: A retrospective study was conducted to analyse the replacement skills and clinical data of 13 patients who had been treated for reversal intertrochanteric fracture with minimally invasive process of Kirchner assisted proximal femoral nail antirotation in our department between June 2014 and September 2014. There were 4 males and 9 females with a mean age of 64. 7years( 53-78 years). According to the AO Classification,there were 5 cases of type A3. 1,8 cases of type A3. 3. The Harris scores after operation were analysed. Results: No infection,fat embolism,deep vein thrombosis,nonunion and the deformity of varus and rotation of the hip occurred. No patients were dead. All patients were followed up for 4-6 months. According to the Harris criterion,9 cases were rated as excellent,3 good and 1 fair. All patients get good replacement. Conclusion: The closed replacement and minimally invasive process of Kirchner assisted proximal femoral nail antirotation are easy to operate and useful to the replacement of fractures and the protection of extramedullary blood supply. They are advisable choices for the treatment of reversal intertrochanteric fracture.