CAJ | 학술논문

目的探讨股骨干骨折闭合复位髓内钉固定术中利用大转子倾斜指数指导旋转力线恢复的有效性. 方法 2011年1月至2012年1月采用闭合复位髓内钉固定治疗24例股骨干骨折患者,男20例,女4例；年龄17 ～61岁,平均36.5岁；均为单侧闭合性骨折.骨折AO分型:32A2型11例,32B2型8例,32C2型5例.闭合复位髓内钉固定术中根据大转子倾斜指数计算出股骨近端的旋转角度及状态:若股骨近折端外旋≥15°,则采用Schanz钉内旋技术纠正外旋畸形,然后插入髓内钉并锁定；若股骨近折端外旋＜15°,则先插入髓内钉,锁定近端,然后旋转股骨远端,纠正旋转畸形,锁定远端.术后应用CT测量并比较患者患肢与健肢的股骨颈前倾角,判断旋转复位情况. 结果 24例患者术后患肢与健肢股骨颈前倾角平均分别为15.36°±7.91°、14.54°±7.44°,二者比较差异无统计学意义(t=0.958,P=0.348).患肢与健肢股骨颈前倾角差值平均为3.58°±2.26°.所有患者旋转畸形均＜9°,其中股骨远折端内旋畸形15例,外旋畸形8例,无旋转畸形1例.24例患者术后获8 ～ 20个月(平均13个月)随访.骨折均获愈合,愈合时间为3～7个月,平均5.1个月.无骨不连、膝关节僵硬等并发症发生. 结论应用大转子倾斜指数指导股骨干骨折闭合复位髓内钉固定术,能准确判断股骨近端的旋转状态,有助于纠正旋转移位,降低术后旋转对位不良的发生率.
목적 탐토고골간골절폐합복위수내정고정술중이용대전자경사지수지도선전력선회복적유효성. 방법 2011년1월지2012년1월채용폐합복위수내정고정치료24례고골간골절환자,남20례,녀4례；년령17 ～61세,평균36.5세；균위단측폐합성골절.골절AO분형:32A2형11례,32B2형8례,32C2형5례.폐합복위수내정고정술중근거대전자경사지수계산출고골근단적선전각도급상태:약고골근절단외선≥15°,칙채용Schanz정내선기술규정외선기형,연후삽입수내정병쇄정；약고골근절단외선＜15°,칙선삽입수내정,쇄정근단,연후선전고골원단,규정선전기형,쇄정원단.술후응용CT측량병비교환자환지여건지적고골경전경각,판단선전복위정황. 결과 24례환자술후환지여건지고골경전경각평균분별위15.36°±7.91°、14.54°±7.44°,이자비교차이무통계학의의(t=0.958,P=0.348).환지여건지고골경전경각차치평균위3.58°±2.26°.소유환자선전기형균＜9°,기중고골원절단내선기형15례,외선기형8례,무선전기형1례.24례환자술후획8 ～ 20개월(평균13개월)수방.골절균획유합,유합시간위3～7개월,평균5.1개월.무골불련、슬관절강경등병발증발생. 결론 응용대전자경사지수지도고골간골절폐합복위수내정고정술,능준학판단고골근단적선전상태,유조우규정선전이위,강저술후선전대위불량적발생솔.
Objective To assess the usage of the greater trochanter tilting index in the close reduction and intramedullary nail fixation of femoral shaft fracture for correction of rotational deformity.Methods From January 2011 to January 2012 we treated 24 patients with one-sided and closed femoral shaft fracture.They were 20 men and 4 women,aged from 17 to 61 years (average,36.5 years).By AO classification,11 cases were of 32A2,8 of 32B2 and 5 of 32C2.After the anteroposterior radiograph of the proximal femur was taken,its rotational angle was calculated according to the greater trochanter tilting index.When the external rotation angle of the proximal femur was ≥ 15°,the Schanz pin skill was used to rectify the extorsion before inserting the main intramedullary nail; when the angle was ＜ 15°,the main intramedullary nail was inserted and the proximal locking screws were locked before the rotational deformity was corrected.The anteversion angles of both healthy and affected sides were measured and compared to judge the rotation reduction quality using CT scans.Results In the 24 patients,the anteversion angle was 15.36°± 7.91° at the affected side and 14.54° ± 7.44° at the healthy side,showing no statistically significant difference (t =0.958,P =0.348).The mean value of D-values between the affected and healthy sides (deformity degrees) was 3.58°± 2.26°.The deformity degrees of all patients averaged less than 9°.Fifteen cases had internally rotational deformity at the distal fracture end,8 externally rotational deformity and one no deformity.The 24 patients were followed up for 8 to 20 months (average,13 months).All fractures obtained union after an average of 5.1 months (from 3 to 7 months).No complications like bone nonunion or knee stiffness were found.Conclusion The greater trochanter tilt index can be used as an aid in close reduction and intramedullary nail fixation of femoral shaft fracture because it can help judge the rotational state of the proximal femurs so as to correct the deformity and reduce the incidence of malalignment after operation.