大粗隆顶点开口顺行带锁髓内钉治疗青少年股骨干骨折疗效观察

发布时间：2018-03-20 08:19

本文选题：带锁髓内钉　切入点：股骨干骨折　出处：《中国修复重建外科杂志》2017年03期 　论文类型：期刊论文

【摘要】：目的探讨大粗隆顶点开口顺行带锁髓内钉治疗青少年股骨干骨折的疗效。方法 2011年6月—2015年6月,采用闭合复位大粗隆顶点开口顺行带锁髓内钉治疗23例青少年股骨干骨折。其中男19例,女4例;年龄13岁6个月~17岁,平均15.2岁。体质量40~77 kg,平均53.5 kg。致伤原因:交通事故伤13例,运动伤7例,摔伤3例。骨折位置:股骨干上1/3 6例,中1/3 10例,下1/3 7例。骨折类型:横形骨折10例,斜形骨折6例,螺旋形骨折1例,粉碎性骨折6例。受伤至手术时间3~17 d,平均6.2 d。末次随访时于双下肢全长X线片,测量双下肢长度、颈干角、股骨颈直径、股骨头最高点平面与股骨大粗隆顶点平面间距离(articulotrochanteric distance,ATD)。结果患者术后切口均Ⅰ期愈合,无感染等早期并发症发生。23例均获随访,随访时间15~36个月,平均26.5个月。术后患者均无疼痛,步态正常,无跛行,均恢复日常生活及运动。X线片复查示,骨折均愈合,临床愈合时间5~13个月,平均6.5个月;均无骨折不愈合、延迟愈合及超过5°的畸形愈合、旋转畸形发生。术后12~24个月取出内固定物,平均19.5个月。随访期间无异位骨化及再骨折发生,无股骨近端发育畸形及股骨头缺血性坏死发生。2例术后大粗隆骨骺早闭,但步态无影响;2例双下肢不等长,但双下肢差值1 cm;均无需手术处理。末次随访时健、患侧颈干角分别为(131.7±6.3)、(132.9±7.8)°,股骨颈直径分别为(34.1±3.2)、(33.9±3.8)mm,ATD分别为(27.8±9.2)、(26.5±8.5)mm,比较差异均无统计学意义(t= 0.24,P=0.86;t=0.18,P=0.92;t=1.03,P=0.49)。结论大粗隆顶点开口顺行带锁髓内钉治疗青少年股骨干骨折固定可靠,是一种有效的手术方法。
[Abstract]:Objective to investigate the therapeutic effect of anterograde interlocking intramedullary nail at the vertex of great trochanter in the treatment of juvenile femoral shaft fracture. Methods from June 2011 to June 2015, A total of 23 cases of juvenile femoral shaft fractures were treated by closed reduction of anterograde interlocking intramedullary nail with large trochanter vertex, including 19 males and 4 females, aged 13 years, 6 months and 17 years. The average age was 15.2 years old. The body mass was 4077 kg, the average was 53.5 kg.The causes of injury were: 13 cases of traffic accident injury, 7 cases of sports injury, 3 cases of falling injury. Fracture location: 1/3 cases of femoral shaft, 1/3 cases of 1/3 cases, 1/3 cases of lower 1/3 cases. Type of fracture: 10 cases of transverse fracture. 6 cases of oblique fracture, 1 case of spiral fracture, 6 cases of comminuted fracture. The time from injury to operation was 317 days (mean 6.2 days). The distance between the plane of the highest point of femoral head and the plane of femoral trochanter vertex was analyzed. Results the incision healed in one stage after operation, and the early complications, such as no infection, were followed up in all the 23 cases. The follow-up time was 15 ~ 36 months. The average of 26.5 months was 26.5 months. The patients had no pain, normal gait, no claudication, recovery of daily life and exercise. X-ray examination showed that all the fractures healed, the clinical healing time was 5 ~ 13 months (mean 6.5 months), and none of them had fracture nonunion. Delayed healing, malunion of more than 5 掳, malformation of rotation occurred. Internal fixation was removed 1224 months after operation, with an average of 19.5 months. No heterotopic ossification or refracture occurred during follow-up. There were no proximal femoral deformities and avascular necrosis of femoral head in 2 cases with premature closure of the epiphysis of great trochanter, but there was no effect on gait in 2 cases, but the difference of both lower limbs was 1 cm. The neck trunk angle of the affected side was 131.7 卤6.3 卤132.9 卤7.8 掳, and the diameter of femoral neck was 34.1 卤3.2mm and 33.9 卤3.8mm respectively. The ATD was 27.8 卤9.2 卤8.5mm. there was no significant difference between the two groups (t = 0.24, P 0.86 ~ 0.86 t = 0.18, P ~ (0.92) T 1.03P ~ (0.49)). Conclusion the interlocking intramedullary nail is a reliable and effective surgical method for the treatment of juvenile femoral shaft fracture.
【作者单位】：唐山市第二医院小儿骨科;
【分类号】：R726.8

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