同侧股骨颈骨折合并转子下骨折手术疗效分析

发布时间：2018-06-28 19:26

本文选题：转子下骨折 + 股骨颈骨折　；参考：《中国修复重建外科杂志》2017年09期

【摘要】：目的探讨应用髓内钉联合选择性钢缆环扎固定同侧股骨颈骨折合并转子下骨折的疗效。方法 2012年6月—2015年12月,通过闭合复位股骨颈骨折,应用微创切口髓内钉联合选择性钢缆环扎固定同侧股骨颈骨折合并转子下骨折19例。男5例,女14例;年龄35~77岁,中位年龄52岁。致伤原因:交通事故伤17例,摔伤2例。股骨颈骨折根据Garden分型:Ⅱ型7例,Ⅲ型8例,Ⅳ型4例;股骨转子下骨折根据Seinsheimer分型:Ⅱ型9例,Ⅲ型5例,Ⅳ型3例,Ⅴ型2例。受伤至手术时间2~7 d,平均3.7 d。结果手术时间58~125 min,平均82.4 min;术中出血量225~725 m L,平均289.5 m L。术后切口均Ⅰ期愈合,无感染等早期并发症发生。19例均获随访,随访时间12~18个月,平均13.9个月。术后1个月患者尖顶距为9~23 mm,平均15.2 mm。患者骨折均愈合,愈合时间18~42周,平均27.4周;其中1例术后3个月出现轻度髋内翻,股骨颈出现轻度移位,颈干角约122°,术后42周骨折愈合。5例患者主诉骨折处轻微疼痛,不影响正常生活,疼痛视觉模拟评分(VAS)为1~3分,平均1.8分;其余患者VAS评分均为0分。16例患者逐渐恢复至术前行走水平。随访期间无骨不连、股骨头缺血性坏死、内固定失败、螺钉切出及钢缆松动等并发症发生。末次随访时Harris髋关节功能评分(HHS)为72~92分,平均82.8分;15例患者(78.9%)髋关节功能良好。结论髓内钉联合选择性钢缆环扎固定同侧股骨颈骨折合并转子下骨折,能够通过提供良好的稳定性恢复髋关节功能。
[Abstract]:Objective to investigate the effect of intramedullary nail combined with selective cable ligation for the fixation of the intertrochanteric fracture of the femoral neck. Methods from June 2012 to December 2015, 19 cases of femoral neck fracture combined with selective intramedullary cable cerclage fixation combined with selective intramedullary cervical intramedullary nail were used to fix the fracture of the femoral neck with a closed reduction of the femoral neck fracture. 5 males and females were treated with a minimally invasive incision of intramedullary nailing and selective steel cable cerclage. 14 cases, age 35~77, middle age 52. The cause of injury: 17 cases of traffic accidents and 2 cases of WwM. Femoral neck fracture according to Garden classification: type II 7 cases, type III 8 cases, type IV 4 cases, femoral subtrochanteric fracture according to Seinsheimer classification: type II 9 cases, type III 5 cases, type IV 3 cases, and type 2 cases. The injury to operation time is D, mean 3.7 D. results 58 operation time 58 ~125 min, average 82.4 min; intraoperative bleeding volume 225~725 m L, average 289.5 m L. incision were all first stage healing, no infection and other early complications of.19 cases were all followed up, followed up for 12~18 months, average 13.9 months. 1 months after operation, the spires were 9~23 mm, average 15.2 fractures healed, healing time, an average of 27.4 weeks; 1 cases had mild hip varus at 3 months after operation, slight dislocation of the neck of femur, 122 degrees of neck dry angle, 42 weeks of fracture healing in.5 patients complained of slight pain in the fracture, and no influence on normal life. The visual analogue score of pain (VAS) was 1~3, average 1.8, and the other patients with VAS score were 0.16 patients gradually recovered to preoperative walking. There were no bone nonunion, avascular necrosis of the femoral head, failure of internal fixation, screw cutting and loosening of steel cable during the follow-up period. The Harris hip function score (HHS) was 72~92 score, average 82.8 points at the last follow-up, and 15 patients (78.9%) had good hip function. Fracture of the subtrochanteric fracture can restore the hip joint function by providing good stability.
【作者单位】：同济大学附属上海市第十人民医院骨科;
【基金】：上海市自然科学基金项目(14ZR1432600)~~
【分类号】：R687.3

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