Hip fractures,especially intertrochanteric fractures,are more common with aging.After decades of progress,it is a general consensus to carry out internal fixation for this group of patients.However,the recent focus is...Hip fractures,especially intertrochanteric fractures,are more common with aging.After decades of progress,it is a general consensus to carry out internal fixation for this group of patients.However,the recent focus is on unstable intertrochanteric fractures to ensure better prognosis and prevent internal fixation failure.The lateral femoral wall,as a novel concept,is often disregarded.Many scholars have recognized that the lateral wall of the proximal femoral plays a crucial role in the stability of internal fixation for intertrochanteric fractures.In this paper,the historical evolution,definition,clinical significance,injury classification,choice of internal fixation,and possible prognosis of lateral femoral wall fracture are reviewed in order to provide clinicians strong evidence of treatment strategies.展开更多
Purpose:Intramedullary implants are well accepted fixation of all types of intertrochanteric(IT)frac-tures,both stable and unstable types.Intramedullary nails have an ability to effectively support the posteromedial p...Purpose:Intramedullary implants are well accepted fixation of all types of intertrochanteric(IT)frac-tures,both stable and unstable types.Intramedullary nails have an ability to effectively support the posteromedial part,but fail to buttress the broken lateral wall requiring lateral augmentation.The aim of this study was to evaluate the outcome of proximal femoral nail augmented with trochanteric buttress plate for broken lateral wall with IT fractures,which was fixed to the femur through hip screw and anti-rotation screw nail.Methods:Of 30 patients,20 had Jensen-Evan typeⅢand 10 had type V fractures.Patients with IT fracture of broken lateral wall and aged more than 18 years,in whom satisfactory reduction was achieved by closed methods,were included in the study.Patients with pathologic or open fractures,polytrauma,prior hip surgery,non-ambulatory prior to surgery,and those who refused to participate were excluded.The operative time,blood loss,radiation exposure,quality of reduction,functional outcome,and union time were evaluated.All data were coded and recorded in Microsoft Excel spread sheet program.SPSS 20.0 was used for data analysis and normality of the continuous data was checked using Kolmogorv Smirnov test.Results:The mean age of patients in the study was 60.3 years.The mean duration of surgery(min),mean intra-operative blood loss(mL)and mean number of exposures were 91.86±12.8(range 70-122),144.8±3.6(range 116-208),and 56.6(range 38-112),respectively.The mean union time was 11.6 weeks and the mean Harris hip score was 94.1.Conclusion:Lateral trochanteric wall in IT fractures is significantly important,and needs to be recon-structed adequately.Nail-plate construct of trochanteric buttress plate fixed with hip screw and anti-rotation screw of proximal femoral nail can be successfully used to augment,fix or buttress the lateral trochanteric wall giving excellent to good results of early union and reduction.展开更多
目的:探讨锁定钢板内固定治疗股骨近端外侧壁骨折块后的效果。方法:2021年1月至2022年6月收治31例合并外侧壁骨折的股骨转子间骨折患者,其中15例单纯采用股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)固定,男3例,女12例...目的:探讨锁定钢板内固定治疗股骨近端外侧壁骨折块后的效果。方法:2021年1月至2022年6月收治31例合并外侧壁骨折的股骨转子间骨折患者,其中15例单纯采用股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)固定,男3例,女12例;年龄(75.87±7.46)岁;另16例采用PFNA内固定后再应用预弯好的3.5 mm螺孔锁定钢板内固定外侧壁骨折,男4例,女12例;年龄(76.15±9.47)岁。术后随访观察记录比较两组手术指标、尖顶距(tip-apical distance,TAD)、术后负重站立时间、骨折复位情况。术后6个月根据Harris髋关节评分评价术后髋关节功能。结果:两组患者均获得随访,时间7~17(12±5)个月。两组术后即刻颈干角为111°~132°(119.3±8.3)°。骨折复位效果:PFNA组,优11例,可2例,差1例;PFNA+锁定钢板组,优12例,可3例,差1例。PFNA组1例发生螺旋刀片经股骨头切出。两组手术时间、术中出血量及手术切口长度比较,差异有统计学意义(P<0.05);两组TAD及术后负重站立时间比较,差异无统计学意义(P>0.05)。两组术后6个月Harris各项评分和总分比较,差异有统计学意义(P<0.05)。结论:应用PFNA辅助锁定钢板内固定合并外侧壁骨折的股骨转子间骨折疗效确切,可较好恢复外侧壁完整性,提高PFNA内固定的稳定性,术后并发症少。展开更多
目的探讨无牵引架侧卧位股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定术治疗股骨粗隆间骨折的效果。方法方便选取2018年8月—2021年7月新泰市人民医院行PFNA内固定术治疗的股骨粗隆间骨折患者82例为研究对象,以...目的探讨无牵引架侧卧位股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定术治疗股骨粗隆间骨折的效果。方法方便选取2018年8月—2021年7月新泰市人民医院行PFNA内固定术治疗的股骨粗隆间骨折患者82例为研究对象,以随机数字表分为两组,各41例。研究组行无牵引架侧卧位PFNA内固定术,对照组行常规平卧体位持续牵引PFNA内固定术。比较两组患者髋关节恢复的优良率,手术时间、术中出血量、切口长度、骨折愈合时间及术后并发症情况。结果研究组患者髋关节恢复的优良率95.12%与对照组90.24%对比,差异无统计学意义(χ^(2)=0.180,P>0.05)。研究组手术时间(55.65±10.52)min、术中出血量(82.65±20.44)mL较对照组(90.50±8.98)min、(120.65±18.65)mL更低,差异有统计学意义(t=16.202、8.794,P<0.05),研究组切口长度(5.05±0.45)cm、骨折愈合时间(10.20±1.15)周与对照组(4.99±0.50)cm、(10.49±1.25)周对比,差异无统计学意义(t=0.571、1.093,P>0.05)。研究组术后并发症发生率7.32%与对照组7.32%对比,差异无统计学意义(χ^(2)=0.180,P>0.05)。结论采用无牵引架侧卧位开展PFNA内固定手术,利于缩短股骨粗隆间骨折患的手术时间,降低术后失血量。展开更多
文摘Hip fractures,especially intertrochanteric fractures,are more common with aging.After decades of progress,it is a general consensus to carry out internal fixation for this group of patients.However,the recent focus is on unstable intertrochanteric fractures to ensure better prognosis and prevent internal fixation failure.The lateral femoral wall,as a novel concept,is often disregarded.Many scholars have recognized that the lateral wall of the proximal femoral plays a crucial role in the stability of internal fixation for intertrochanteric fractures.In this paper,the historical evolution,definition,clinical significance,injury classification,choice of internal fixation,and possible prognosis of lateral femoral wall fracture are reviewed in order to provide clinicians strong evidence of treatment strategies.
文摘Purpose:Intramedullary implants are well accepted fixation of all types of intertrochanteric(IT)frac-tures,both stable and unstable types.Intramedullary nails have an ability to effectively support the posteromedial part,but fail to buttress the broken lateral wall requiring lateral augmentation.The aim of this study was to evaluate the outcome of proximal femoral nail augmented with trochanteric buttress plate for broken lateral wall with IT fractures,which was fixed to the femur through hip screw and anti-rotation screw nail.Methods:Of 30 patients,20 had Jensen-Evan typeⅢand 10 had type V fractures.Patients with IT fracture of broken lateral wall and aged more than 18 years,in whom satisfactory reduction was achieved by closed methods,were included in the study.Patients with pathologic or open fractures,polytrauma,prior hip surgery,non-ambulatory prior to surgery,and those who refused to participate were excluded.The operative time,blood loss,radiation exposure,quality of reduction,functional outcome,and union time were evaluated.All data were coded and recorded in Microsoft Excel spread sheet program.SPSS 20.0 was used for data analysis and normality of the continuous data was checked using Kolmogorv Smirnov test.Results:The mean age of patients in the study was 60.3 years.The mean duration of surgery(min),mean intra-operative blood loss(mL)and mean number of exposures were 91.86±12.8(range 70-122),144.8±3.6(range 116-208),and 56.6(range 38-112),respectively.The mean union time was 11.6 weeks and the mean Harris hip score was 94.1.Conclusion:Lateral trochanteric wall in IT fractures is significantly important,and needs to be recon-structed adequately.Nail-plate construct of trochanteric buttress plate fixed with hip screw and anti-rotation screw of proximal femoral nail can be successfully used to augment,fix or buttress the lateral trochanteric wall giving excellent to good results of early union and reduction.
文摘目的探讨无牵引架侧卧位股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定术治疗股骨粗隆间骨折的效果。方法方便选取2018年8月—2021年7月新泰市人民医院行PFNA内固定术治疗的股骨粗隆间骨折患者82例为研究对象,以随机数字表分为两组,各41例。研究组行无牵引架侧卧位PFNA内固定术,对照组行常规平卧体位持续牵引PFNA内固定术。比较两组患者髋关节恢复的优良率,手术时间、术中出血量、切口长度、骨折愈合时间及术后并发症情况。结果研究组患者髋关节恢复的优良率95.12%与对照组90.24%对比,差异无统计学意义(χ^(2)=0.180,P>0.05)。研究组手术时间(55.65±10.52)min、术中出血量(82.65±20.44)mL较对照组(90.50±8.98)min、(120.65±18.65)mL更低,差异有统计学意义(t=16.202、8.794,P<0.05),研究组切口长度(5.05±0.45)cm、骨折愈合时间(10.20±1.15)周与对照组(4.99±0.50)cm、(10.49±1.25)周对比,差异无统计学意义(t=0.571、1.093,P>0.05)。研究组术后并发症发生率7.32%与对照组7.32%对比,差异无统计学意义(χ^(2)=0.180,P>0.05)。结论采用无牵引架侧卧位开展PFNA内固定手术,利于缩短股骨粗隆间骨折患的手术时间,降低术后失血量。
