股骨近端髓内钉治疗股骨转子及其周围骨折

目的评价股骨近端髓内钉(PFN)治疗转子间骨折及转子下骨折的疗效及并发症。方法自2002年1月～2003年12月使用PFN治疗股骨转子及其周围骨折患者185例。结果所有病例随访8～18个月,无切口及骨髓感染病例,平均6个月达到临床骨折愈合标准。结论PFN是一种侵袭性较小、方法简便的治疗转子及其周围骨折的新技术。     

有限切开复位髓内钉固定治疗股骨转子下骨折

目的 探讨有限切开复位髓内钉固定治疗股骨转子下骨折的效果.方法对闭合复位失败的21例股骨转子下骨折患者采用有限切开复位、髓内钉固定治疗.结果 21例均获得随访,时间10～18个月.骨折全部愈合,无内固定物松动、断裂等并发症.术后测量：内外翻成角0°～5°（1.9°±1.7°）;前后成角0°～10°（4.3°±2.6°）;内外旋0°～10°（5.5°±2.6°）;下肢缩短0～1.5（0.4±0.5）cm.结论 有限切开复位髓内钉固定治疗股骨转子下骨折可以获得良好的治疗效果.     

股骨重建髓内钉治疗股骨转子间骨折

目的探讨股骨重建髓内钉治疗股骨转子间骨折的临床疗效。方法对136例股骨转子间骨折患者采用股骨重建髓内钉治疗。结果患者均获随访,时间6～24(16±8)个月,骨折均愈合。髋关节功能Harris评分:优107例,良15例,可14例,优良率为89.7%。发生切口感染1例。结论闭合复位股骨重建髓内钉内固定治疗股骨转子间骨折创伤小,固定可靠,疗效满意。     

股骨近端髓内钉治疗老年人股骨转子间骨折

2004年5月～2010年8月,我们采用股骨近端髓内系统(PFN)内固定治疗转子间骨折患者60例,取得良好的临床效果。1材料与方法1.1病例资料本组60例,男20例,女40例,年龄62～89岁。左侧31例,     

新型股骨近端髓内钉治疗股骨转子间骨折

2009年1月~2010年6月,我科采用新型股骨近端髓内钉(PFNA)结合骨科手术牵引床治疗20例股骨转子间骨折患者,疗效满意.`` 1 材料与方法 1.1 病例资料 本组20例,男5例,女15例.年龄56～90岁.骨折按AO分型:A1型10例,A2 型6例,A3型4例.其中合并其它损伤者3例.伤后至手术时间3 h～7 d.     

股骨重建髓内钉治疗股骨转子下骨折的疗效

目的 探讨股骨重建髓内钉治疗股骨转子下骨折的疗效。方法 采用股骨重建髓内钉治疗42例股骨转子下骨折患者。记录手术情况、骨折愈合情况、术后并发症发生情况,末次随访时采用髋关节功能Harris评分、膝关节功能HSS评分评价疗效。结果 患者均获得随访,时间15～20个月。手术时间44～91(68.88±13.28)min,术中出血量40～120(83.21±17.42)ml,术后住院时间3～8(5.31±1.16)d。38例骨折愈合时间为3～6(4.03±0.72)个月,2例骨折在术后第10、11个月愈合,2例骨折不愈合经再次手术后愈合。术后切口感染2例,中重度贫血(血红蛋白<70 g/L)4例,螺钉退钉切出2例,髋内翻畸形1例,压疮2例。末次随访时,髋关节功能Harris评分为78～97(93.86±3.14)分,其中优39例,良1例,可2例,优良率为95.24%;膝关节功能HSS评分为91～97(94.69±1.52)分,42例均为优。结论 股骨重建髓内钉是治疗股骨转子下骨折良好的内固定方式,尤其适用于中青年患者。     

股骨近端髓内钉＋记忆合金骨卡环治疗复杂股骨转子下骨折

2004年6月～2006年8月，我科采用股骨近端带锁髓内钉＋记忆合金骨卡环内固定治疗Seinsheilner Ⅳ、Ⅳ型股骨转子下骨折14例．取得了良好疗效     

股骨近端防旋髓内钉治疗股骨转子间骨折

<正>2010年3月~2012年8月,我们对46例股骨转子间骨折患者采用股骨近端防旋髓内钉(PFNA)固定治疗,获得良好疗效,报道如下。1材料与方法1.1病例资料本组46例,男19例,女27例,年龄61~85岁。按Evans骨折分型:Ⅱ型6例,Ⅲ型21例,Ⅳ型19例。受伤至手术时间2~7 d。1.2治疗方法全身麻醉。C臂机透     

股骨近端防旋髓内钉治疗股骨转子间骨折

正2011年5月~2014年10月,我们采用股骨近端防旋髓内钉(PFNA)治疗43例股骨转子间骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组43例,男16例,女27例,年龄56~83岁。均为闭合骨折。骨折按AO分型:A1型9例,A2型19例,A3型15例。受伤至手术时间2~6 d。1.2治疗方法椎管内麻醉。患者侧     

股骨近端防旋髓内钉治疗老年股骨转子间及转子下骨折

<正>2010年6月~2013年6月,我科采用股骨近端防旋髓内钉(PFNA)治疗26例老年股骨转子间及转子下骨折患者,疗效满意。1材料与方法1.1病例资料本组26例,男11例,女15例,年龄65~87岁。其中股骨转子间骨折18例,按AO分类:A1型8例,A2型9例,A3型1例。股骨转子下骨折8例,按AO分类:A型4例,B型4例。均为闭合非病理性骨折。24例患     

Outcome of traumatic subtrochanteric femoral fractures fixed using cephalo-medullary nails

We performed a retrospective review of 101 patients sustaining 102 traumatic, non-pathological subtrochanteric fractures treated with cephalo-medullary nailing over a period of 6 years from 1999 to 2005. Mean follow up was 24 weeks (range: 6-96). Twenty patients were lost to follow up and 21 died, whilst 57 of 60 fractures were followed to union. There were 19 fractures fixed in varus, as defined as a varus angulation of greater than 10 degrees at the fracture site. Implant failure, 9 of the 10 malunions and all 3 of the non-unions occurred in the varus group whilst only 1 malunion occurred in the satisfactory reduction group. This difference in outcome is statistically significant (p<0.0001). Twenty four of the 60 patients had undergone open reduction at the time of fixation. There were three malunions and one non-union in the open reduction group compared with six and two, respectively in the closed group (p>0.05). Post-operative recovery rates, infection rates and other complications were similar for both groups. We therefore advocate the use of open reduction where necessary to avoid varus malreduction to avoid such complications, particularly as open reduction was not associated with a higher complication rate in this series. The study supports the use of cephalo-medullary nailing for subtrochanteric fractures with a union rate of 95%.     

Classification of subtrochanteric femoral fractures

A review of the literature identified 15 different classification methods for subtrochanteric femoral fractures. Only eight of those classifications defined the area of bone, which constituted a subtrochanteric fracture. The actual length of femur defined as the subtrochanteric zone varied from 3 cm up to the level of the femoral isthmus. There was no agreement between the different classifications regarding the proximal and distal border or for those fractures, which traverse anatomical boundaries. In the various classifications, fractures were subdivided into 2-15 subgroups. The majority of the identified studies were unable to find the classifications useful in either determining treatment or predicting the outcome after treatment. We subdivided subtrochanteric fractures into three types based on the degree of fracture comminution. We examined the inter- and intra-observer agreement of our recommended classification. One orthopaedic consultant, one specialist hip fracture surgeon, two trainee registrar orthopaedic surgeons and one specialty trainee in orthopaedics, on two different occasions, 8 weeks apart, independently classified the radiographs of 20 patients with a subtrochanteric fracture. The mean kappa value for inter- and intra-observer variation was 0.71 and 0.79, respectively, with both showing substantial agreement and, therefore, this simpler classification is recommended. Based on the review of previous classification methods, we also recommend that the subtrochanteric zone be defined as the one in which the fracture line crossing the femur is predominantly within the area of bone extending 5 cm below the lower border of the lesser trochanter.     

Comparison of extramedullary and intramedullary devices for treatment of subtrochanteric femoral fractures at tertiary level center

Objective： The treatment of subtrochanteric fractures is challenging and treatment modalities and implants are constantly evolving. This study attempts to revisit and compare extramedullary vs. intramedullary devices in relatively young population. Methods： Thirty patients with subtrochanteric fractures were enrolled and treated with extramedullary or intramedullary devices and follow-up continued one year for clinico-radiological assessment. Results： The mean age of patients was 37,53 years. Most were males between 21-40 years. The dominant mode of injury was traffic accidents （66%）. Fractures were classified according to Russell-Taylor classification. Forty percent were Russell-Taylor type IA, 37% type IB and 23% type IIA. Average time to surgery was 3.6 days from the time of admission to hospital. Mean duration of surgery was 45 minutes for intramedullary device （group A） and 105 minutes for extramedullary device （group B）. Average blood loss was 100 ml in group A and 200 ml in group B. Mean duration of radiation exposure was 130 seconds and 140 seconds for groups A and B, while average duration of hospital stay was 12 days and 16 days respectively. Excellent results were seen in 47% of cases in group A and 33% of cases in group B. Conclusion： Intramedullary device is a reliable implant for subtrochanteric fractures. It has high rates of union with minimal soft-tissue damage. Intramedullary fixation has biological and biomechanical advantages, but surgery is technically demanding. Gradual learning and patience is needed to make this method truly rewarding.     

Intramedullary versus extramedullary fixation in the treatment of subtrochanteric femur fractures: A comprehensive systematic review and meta-analysis

ObjectiveThis meta-analysis aimed to compare the clinical outcomes of intramedullary fixation with the extramedullary fixation in the surgical management of subtrochanteric fractures by analyzing relevant randomized controlled trials (RCTs) and retrospective cohort studies (RCSs).MethodsThe PubMed, Embase, Cochrane Library, Wanfang database, and Chinese National Knowledge Infrastructure (CNKI) were searched from their inception till June 29, 2020. Two reviewers extracted the data, including operation time, intraoperative blood loss, fluoroscopy time, length of stay, union time, nonunion rate, infection rate, implant failure rate, reoperation rate, Harris hip score, and mortality rate. The Cochrane risk-of-bias tool and the Newcastle-Ottawa quality assessment scale were used to evaluate the methodological quality of RCTs and RCSs, respectively. Statistical heterogeneity was quantitatively evaluated with the I2 statistic.ResultsThere were no significant differences in operation time, intraoperative blood loss, average length of stay in hospital, infection rate, implant failure rate, Harris hip scores, and mortality rate. Intramedullary nail could achieve shorter union time (MD=−1.77, 95% CI −3.40~−0.14, p=0.03), lower nonunion rate (RR=0.36, 95%CI 0.14~0.97, p=0.04), and reoperation rate (RR=0.46, 95% CI 0.24~0.89, p=0.02) than extramedullary fixations. The subgroup analysis indicated that intramedullary nail was superior than extramedullary fixations in operation time, reoperation rate, and Harris hip scores in the ≥60-year subgroup. However, the intraoperative blood loss in intramedullary nail group was significantly higher than that of extramedullary fixation group in the <60-year subgroup.ConclusionThe results of this study have revealed that intramedullary fixation can confer shorter union time, lower nonunion, and reoperation rates compared with extramedullary fixations. Therefore, intramedullary fixation should be considered as the first selection for the treatment of patients with subtrochanteric fractures.Level of EvidenceLevel II, Therapeutic study     

改良梅花型交锁髓内钉固定股骨粗隆下骨折的生物力学研究

目的比较自行设计的改良梅花型交锁髓内钉与国产Gamma钉固定股骨粗隆下骨折的即刻生物力学特性,探讨改良梅花型交锁髓内钉固定股骨粗隆下骨折的可行性。方法 8具成年健康男性股骨标本,按左右侧分为实验组和对照组,分别制作股骨粗隆下横形骨折模型。实验组采用长度350 mm的改良梅花型交锁髓内钉固定骨折,对照组采用长度350 mm国产Gamma钉固定骨折。分别检测抗轴向压缩、抗侧弯及抗扭转力学性能,并进行统计学分析。结果 1 000 N轴向载荷压力下的抗压刚度、1 000 N压力下的抗弯曲刚度及3 N/m下的抗扭转刚度:对照组分别为(2 359.4±200.8)N/mm、(614.7±60.2)N/m、(0.64±0.16)Nm/°,实验组分别为(2 178.1±129.5)N/mm、(439.1±48.2)N/m、(0.48±0.13)Nm/°。两组抗压、抗弯曲、抗扭转3项指标比较差异均无统计学意义(P>0.05)。结论改良梅花型交锁髓内钉具有较好的生物力学性能,可用于内固定治疗股骨粗隆下横形骨折。     

Role of percutaneous cerclage wire in the management of subtrochanteric fractures treated with intramedullary nails

Purpose: Cerclage wire application has emerged as a potential therapeutic adjunct to intramedullary nailing for subtrochanteric fractures. But its popularity is plagued by the concern of possible negative effect on fracture zone biology. This study was intended to analyze the clinico-radiological outcome and complications associated with cerclage wire application. Methods: Retrospective analysis was performed on all the subtrochanteric fractures operated with intramedullary nailing between January 2012 and January 2016. After exclusion, 48 patients were available with an average follow-up of 20.8 months. Long oblique, spiral, spiral wedge or comminuted fracture configurations with butterfly fragments were particularly considered for cerclage wire application, which was employed by percutaneous cerclage passer in 21 patients. Assessment was done in terms of operation time, blood loss, quality of reduction, neck-shaft angle, follow-up redisplacement, union time, complications, and final functional evaluation by Merle d’Aubigne''-Postel score. Results: Average operation time and blood loss were significantly higher in cerclage group (p < 0.05). However, cerclage use substantially improved quality of reduction in terms of maximum cortical displacement (p = 0.003) and fracture angulation (p = 0.045); anatomical reduction was achieved in 95.23% of cases as compared to 74.07% without cerclage. Union time was shorter, although not statistically different (p = 0.208), in cerclage group. Four patients in non-cerclage group developed non-union, 2 of them had nail breakage. No infection or any other implant related complications were reported with cerclage use. Conclusion: Minimally-invasive cerclage wire application has proved to be beneficial for anatomical reconstruction in difficult subtrochanteric fractures, whenever applicable, without any harmful effect on fracture biology.     

TRIGEN股骨髓内钉在股骨骨折中的应用

目的探讨TRIGEN股骨髓内钉在股骨骨折中的应用效果。方法对54例股骨骨折患者采用TRIGEN股骨髓内钉治疗,记录髓内钉远端锁钉时间、透视次数、一次锁钉成功率及骨折愈合时间。结果54例均获得随访,时间8~36个月。患者骨折均愈合,愈合时间3~14个月。均无伤口感染、血管神经损伤。Sureshot远端瞄准系统远端锁钉时间为142~412 s,一次锁钉成功率为97.2%,透视次数为1~6次。结论TRIGEN股骨髓内钉治疗股骨骨折治疗效果满意,具有损伤小、固定简便、并发症少等优点;Sureshot远端瞄准系统一次锁钉准确率高、操作时间短、放射量小。     

Management of subtrochanteric femoral fractures and metastases using long proximal femoral nail

We report our initial experience with a new reconstruction nail, the long proximal femoral nail (L.PFN), in the treatment of subtrochanteric femoral fractures and metastases. We performed 52 L.PFN in 49 patients over a period of 18 months with an average follow-up period of 47.7 weeks. Group I consisted of 24 patients, who had L.PFN for traumatic subtrochanteric femoral fractures. Group II consisted of 25 patients, who had L.PFN for femoral metastases and pathological fractures. (Three bilateral.) In nine patients in group I, the fracture was extending to the intertrochnateric region with involvement of the piriformis fossa. Eight patients in group I had open reduction and cerclage cabling of the fracture prior to L.PFN. All the traumatic fractures in group I had united with an average time to union of 19.4 weeks. In eight operations there were technical difficulties with the insertion of proximal locking screws. Five patients in our series had complications but we had no mechanical failures of the implant. L.PFN is a reliable implant for subtrochanteric femoral fractures and metastases. We also showed that open reduction and cerclage cabling of unstable subtrochanteric fractures prior to nailing was not detrimental to fracture healing in our series.     

加长型第三代Gamma钉与加长型PFNA内固定治疗股骨粗隆下骨折的比较研究

目的探讨加长型第3代Gamma钉(pTGN)与加长型股骨近端防旋髓内钉(PFNA-long)内固定治疗股骨粗隆下骨折的手术创伤,并发症及手术效果。方法 86例股骨粗隆下骨折根据手术方法分为pTGN组(41例)和PFNA-long组(45例),对两组手术创伤、围手术期并发症和术后功能恢复情况进行比较。结果所有患者获平均21.5个月随访。两组平均术中失血量、透视时间和切开复位率比较差异有统计学意义(P<0.05),PFNA-long组较pTGN组术中出血量少,透视时间短,但切开复位率较pTGN组高。两组平均手术时间、住院时间和末次随访Harris评分比较差异无统计学意义(P>0.05)。结论两种内固定方法治疗股骨粗隆下骨折均可以减少手术后再创伤,并发症较少,内固定有效可行。     

弓形髓内针治疗股骨胫腓骨骨折

1992～ 1999年我院使用弓形针治疗股骨胫腓骨骨折 98例 ,疗效满意。1　材料与方法1 1　病例资料　本组 98例 ,男 70例 ,女 2 8例 ,年龄 12～ 68岁。车祸 4 5例 ,砸伤 2 0例 ,摔伤 18例 ,挤压伤 15例。损伤部位 :股骨干上段骨折 8例、中段骨折 18例、下段骨折 12例 ;胫骨干上段骨折 10例、中段骨折 2 6例、下段骨折 2 4例。其中包括股骨、胫腓骨骨折经钢板和Ｖ形针、梅花针髓内穿针术后发生弯曲折断 3例。1 2　治疗方法　术前根据股骨胫骨的长短、髓腔的大小选择适当规格的弓形针。股骨在股骨髁上 4ｃｍ即髌骨上缘股骨轴线两侧傍开 5ｃｍ各作…