文章摘要

股骨转子间骨折内侧皮质正性支撑对于股骨近端防旋髓内钉疗效的影响

作者: 1许晓, 1周业金, 1李业奎, 1盛桢
1 安徽医科大学第三附属医院创伤骨科,合肥 230001
通讯: 周业金 Email: 1505406085@qq.com
DOI: 10.3978/j.issn.2095-6959.2020.09.032

摘要

目的:分析股骨转子间骨折获得内侧皮质正性支撑对于股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)疗效的影响。方法:回顾性分析2017年1至2019年1月安徽医科大学第三附属医院采用PFNA治疗的股骨转子间骨折(AO/OTA31A2型)113例,其中男43例,女70例。根据术后X线片正位片中头颈骨块内侧皮质与股骨干内侧皮质相对位置关系,将行PFNA治疗的股骨粗隆间骨折患者分为正性支撑组(n=75),中性支撑组(n=21),负性支撑组(n=17)。比较3组年龄、性别、手术时间、术中出血量、术后即刻尖顶距、术后完全负重时间、股骨颈长度丢失、颈干角丢失、髋关节Harris评分。结果:患者均获得完整随访,随访时间8~14(平均10.6)个月。3组年龄、性别、手术时间、术中出血量及术后即刻尖顶距的比较差异无统计学意义(P>0.05)。比较术后6个月随访影像学检查与术后即刻X线片,获得内侧皮质正性支撑患者的术后完全负重时间、股骨颈长度丢失及颈干角变化明显少于负性支撑患者,术后6个月正性支撑组髋关节Harris评分高于负性支撑组,差异均有统计学意义(均P<0.05)。结论:股骨转子间骨折复位中正性支撑时,头颈骨块与股骨干间可获得更稳定的支撑,有效避免并发症的发生。
关键词: 股骨转子间骨折;正性支撑;内侧皮质;股骨近端防旋髓内钉

Effect of fracture reduction with positive medial cortical support on unstable pertrochanteric fractures treated with proximal femoral nail antirotation

Authors: 1XU Xiao, 1ZHOU Yejin, 1LI Yekui, 1SHENG Zhen
1 Department of Traumatic Orthopedics, Third Hospital Affiliated to Anhui Medical University, Hefei 230001, China

CorrespondingAuthor: ZHOU Yejin Email: 1505406085@qq.com

Abstract

Objective: To make a contrastive analysis of effect of fracture reduction with positive medial cortical support on unstable pertrochanteric fractures treated with proximal femoral nail antirotation (PFNA). Methods: A total of 113 patients (43 men and 70 women) with AO/OTA 31A2 hip fractures treated with PFNA between January 2017 and January 2019 in Traumatic Orthopedics of the Third Hospital Affiliated to Anhui Medical University was retrospectively analysed. The patients were divided into a positive medial cortical support group (n=75), a neutral medial cortical support group (n=21) and a negative medial cortical support group (n=17) based on the relationship between the medial cortex of the head and neck and that of the femoral shaft on the postoperative X-ray film. Age, sex ratio, operation time, blood loss, tip-apex distance, postoperative radiographic femoral neck length loss and neck-shaft angle loss, hip Harris score and complications were compared between the three groups. Results: All patients were followed up for 8 to 14 months, with an average of 10.6 months. There were no statistical differences between the three groups in age, sex ratio, operation time, blood loss and tip-apex distance (P>0.05). According to the imageological examination and the postoperative X-ray film in 6-month follow-up, patients in positive medial cortical support reduction group had significantly less loss in neck length and neck-shaft angle than those in negative reduction group. The former group had higher hip Harris scores (P<0.05). Conclusion: Fracture reduction with positive medial cortical support can build more stable support between femoral head-neck fragment and femoral shaft, and effectively avoid the incidence of postoperative complications.
Keywords: pertrochanteric fractures; positive support; medial cortex; proximal femoral nail antirotation