中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2012年
7期
621-625
,共5页
俞银贤%吴晓明%高堪达%高伟%李凡%黄建华%汪方%吴小峰%周孜辉%王秋根
俞銀賢%吳曉明%高堪達%高偉%李凡%黃建華%汪方%吳小峰%週孜輝%王鞦根
유은현%오효명%고감체%고위%리범%황건화%왕방%오소봉%주자휘%왕추근
髋骨折%骨折固定术,内%内固定器
髖骨摺%骨摺固定術,內%內固定器
관골절%골절고정술,내%내고정기
Hip fractures%Fracture fixation,internal%Internal fixators
目的 总结小转子未累及的不稳定股骨转子间骨折的手术复位技巧.方法 回顾性分析2007年1月至2010年12月收治的74例AO/OTA分型中31-A3.1和31-A3.2型股骨转子间骨折资料,男33例,女41例;年龄36～87岁,平均71岁;左侧40例,右侧34例.致伤原因:交通伤27例,跌伤43例,坠落伤3例,压砸伤l例.采用撬拨技术、Homann拉钩技术、钳夹技术、有限切开等进行复位,复位后均行股骨近端髓内钉固定治疗.记录临床和影像学结果,根据Harris髋关节功能评分标准,评价术后髋关节功能.结果 74例骨折复位均在透视下进行,其中闭合复位73例,有限切开复位1例.平均手术时间(75±4) min,平均术中失血量(135±5) ml,平均透视次数(24±3)次.术后65例患者获得8～23个月的随访(平均14.5个月),骨折愈合时间为4～9个月,平均7.4个月.末次随访时Harris髋关节功能评分为87～95分,平均91.4分,其中优29例,良31例,可5例,优良率为92.3％(60/65).结论 小转子未累及的不稳定股骨转子间骨折复位困难,尤其对年龄较轻、肌肉发达的患者,需要借助一定的手术复位技巧,以取得更好的治疗疗效.
目的 總結小轉子未纍及的不穩定股骨轉子間骨摺的手術複位技巧.方法 迴顧性分析2007年1月至2010年12月收治的74例AO/OTA分型中31-A3.1和31-A3.2型股骨轉子間骨摺資料,男33例,女41例;年齡36～87歲,平均71歲;左側40例,右側34例.緻傷原因:交通傷27例,跌傷43例,墜落傷3例,壓砸傷l例.採用撬撥技術、Homann拉鉤技術、鉗夾技術、有限切開等進行複位,複位後均行股骨近耑髓內釘固定治療.記錄臨床和影像學結果,根據Harris髖關節功能評分標準,評價術後髖關節功能.結果 74例骨摺複位均在透視下進行,其中閉閤複位73例,有限切開複位1例.平均手術時間(75±4) min,平均術中失血量(135±5) ml,平均透視次數(24±3)次.術後65例患者穫得8～23箇月的隨訪(平均14.5箇月),骨摺愈閤時間為4～9箇月,平均7.4箇月.末次隨訪時Harris髖關節功能評分為87～95分,平均91.4分,其中優29例,良31例,可5例,優良率為92.3％(60/65).結論 小轉子未纍及的不穩定股骨轉子間骨摺複位睏難,尤其對年齡較輕、肌肉髮達的患者,需要藉助一定的手術複位技巧,以取得更好的治療療效.
목적 총결소전자미루급적불은정고골전자간골절적수술복위기교.방법 회고성분석2007년1월지2010년12월수치적74례AO/OTA분형중31-A3.1화31-A3.2형고골전자간골절자료,남33례,녀41례;년령36～87세,평균71세;좌측40례,우측34례.치상원인:교통상27례,질상43례,추락상3례,압잡상l례.채용효발기술、Homann랍구기술、겸협기술、유한절개등진행복위,복위후균행고골근단수내정고정치료.기록림상화영상학결과,근거Harris관관절공능평분표준,평개술후관관절공능.결과 74례골절복위균재투시하진행,기중폐합복위73례,유한절개복위1례.평균수술시간(75±4) min,평균술중실혈량(135±5) ml,평균투시차수(24±3)차.술후65례환자획득8～23개월적수방(평균14.5개월),골절유합시간위4～9개월,평균7.4개월.말차수방시Harris관관절공능평분위87～95분,평균91.4분,기중우29례,량31례,가5례,우량솔위92.3％(60/65).결론 소전자미루급적불은정고골전자간골절복위곤난,우기대년령교경、기육발체적환자,수요차조일정적수술복위기교,이취득경호적치료료효.
Objective To explore the operative techniques for AO/OTA type 31-A3.1 and 31-A3.2 intertrochanteric fractures fixed with intrameduallary nail.Methods Seventy-four cases of unstable intertrochanteric fracture (AO/OTA type 31-A3.1 and 31-A3.2) from January 2007 to December 2010 were analyzed retrospectively.There were 33 males and 41 females,aged from 36-87 years (mean,71 years).The right hip was involved in 34 patients and the left in 40 patients.The mechanism of injury was traffic injuries in 27 cases,fall damage in 43 cases,injury by falling in 3 case and crush injury in 6 cases.Percutaneous joystick technique,Homann retractor technique,clamp technique and mini-incision was applied to aid reduction during the surgery.All cases were fixed with proximal intrameduallary nail.Clinical and radiographic outcomes were recorded.The postoperative hip function was evaluated using Harris score.Results With the aid of C-arm,closed reduction was performed in 73 cases.Only one patient experienced open reduction because of failure of closed reduction.Sixty-five cases were followed up for 8 to 23 months (mean,14.5 months).Bone union was observed in all cases with the average time of 7.4 months (range,8-23).The operation time,blood loss,the frequency of X-ray exposure was 75±4 minutes,135±5 ml and 24±3 times,respectively.At final follow-up,29 cases were classified as excellent,31 as good,and 5 as fair.The mean Harris hip score was 91.4 points (range,87-95).The overall rate of excellent or good result was 92.3％.Conclusion It is difficult to perform close reduction for unstable intertrochanteric hip fracture (AO/OTA type 31-A3.1and 31-A3.2),especially in relatively young patients.Special operative skills are necessary in some cases.
