目的 探讨31-A3.1和31-A3.2型股骨转子间骨折复位时的手术复位技巧。
方法 回顾性研究本院2007年1月至2010年12月收治的AO/OTA分型31-A3.1和31-A3.2型股骨转子间骨折74例,男性33例,女性41例,平均年龄71岁(36~87岁),均行股骨近端髓内钉内固定治疗,记录临床和影像学结果。
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,术后有65例患者平均随访14.5个月(8~23个月),所有病例在平均7.4个月时均观察到骨折愈合。平均手术时间75+4分钟,平均术中失血量135+5毫升,平均透视次数24+3次,髋关节功能的Harris评分平均91.4分,优良率92.3%。
结论 31-A3.1和31-A3.2型股骨转子间骨折因为骨折未累及小转子,有时闭合复位困难,尤其是患者年龄较轻、肌肉发达时,需要借助一定的手术复位技巧。
关键词 股骨转子间;骨折;髓内钉;复位
Operative technical tips of reduction of intertrochanteric fracture(AO/OTA type 31-A3.1 and 31-A3.2)
YU Yin-xian,WU Xiao-ming,Gao Kan-da,Gao Wei,Li Fang,Huang Jian-hua , Wang Fan,Wu Xiao-feng, Zhou Zhi-hui, Wang Qiu-gen*.Department of Orthopaedics, First People’s Hospital ,Shanghai Jiaotong University, 85 Wujin Road ,Shanghai 200080, China.
[Abstract][Harris, 1969 #486]-ive To explorer the operative technical tips of reduction of intertrochanteric fracture(AO/OTA type 31-A3.1 and 31-A3.2) treated with intrameduallary nail in adults.
Methods 74 cases of unstable intertrochanteric fracture (AO/OTA type 31-A3.1 and 31-A3.2) admitted to our department from January 2007 to December 2010 were analyzed retrospectively,among which,33 were male,and 41 were female,aged from 36~87 years(mean 71 years).All cases were treated with reduction and internal fixation with intrameduallary nail.Clinical results and radiography were evaluated.
Results With the help of C-arm system, 73 cases were treated by closed reduction and only one by open reduction because of failure of closed reduction. 65 cases were
followed up for 8 to 23 months(mean,14.5 months) and bone union was observed in
all cases with the average time of 7.4 months. The time of operation, the blood loss, X-ray fluoroscopic times was 75+4 minutes, 135+5 ml and 24+3 times respectively.
The mean Harris Hip Score was 91.4 points at final evaluation. Good and excellent scores were about 92.3%.
Conclusion It was difficult in close reducting for unstable intertrochanteric hip fracture (AO/OTA type 31-A3.1 and 31-A3.2) in adults,espically in relatively young patients.Operative technical tips were necessary in some cases.
Keywords intertrochanter;fracture;intrameduallary nail;reduction