难复位性股骨粗隆间骨折的影像学特点及手术疗效

目的 :分析难复位性股骨粗隆间骨折的影像学特点,评价闭合撬拨复位髓内钉固定的手术疗效。方法 :自2011年12月至2015年10月,采用闭合撬拨复位髓内钉固定治疗28例难复位性股骨粗隆间骨折患者,男12例,女16例;年龄58~89岁,平均72岁。根据AO分型:A2.1型5例,A2.2型10例,A3.3型13例。观察术后并发症,复查X线片评价骨折愈合情况,采用Harris评分评价髋关节功能。结果:术前X线片判断难复位性股骨粗隆间骨折比较困难,但三维CT有特征性的表现:近骨折端向前旋转移位。手术时间45~100 min,平均65 min。术中出血80~300 ml,平均160 ml。2例患者术后3个月内死亡,26例患者获得随访,时间6~12个月,平均8.4个月。骨折愈合时间12~16周,平均13.6周。术后有2例患者存在内翻畸形,无伤口感染、骨折不愈合和内固定物失效。末次随访髋关节Harris评分为86.7±5.3,优14例,良12例。结论:难复位性股骨粗隆间骨折,术前三维CT可很好的进行预测。闭合撬拨复位髓内钉固定治疗难复位性股骨粗隆间骨折,临床效果满意。

Imaging characteristics and the operative effect of the irreducible femoral intertrochanteric fractures

Objective: To analyse the imaging characteristics of the irreducible femoral intertrochanteric fracture and evaluate the operative effect of closed poking reduction and intramedullary nail fixation. Methods: From December 2011 to October 2015,28 patients with irreducible femoral intertrochanteric fracture were treated by closed poking reduction and intramedullary nail fixation including 12 males and 16 females with an average age of 72 years old ranging from 58 to 89 years old. According to AO classification:5 cases were type A2.1,10 cases were type A2.2,13 cases were type A3.3. The postoperative complications were observed,and the postoperative X-ray were used to evaluate the fracture healing,and the Harris score was used to evaluate the hip joint function. Results: Preoperative X-rays for determine irreducible femoral intertrochanteric fracture was difficult,but dimensional CT had characteristic performance:the fracture near the end displaced forward rotation. Operation time was 45 to 100 minutes with an average of 65 minutes. Intraoperative bleeding was 80 to 300 ml with an average of 160 ml. Two cases died within 3 months after operation,26 patients were followed up for 6 to 12 months with an average of 8.4 months. Fracture healing time was 12 to 16 weeks with an average of 13.6 weeks. Two cases occurred inversion deformity.There were no wound infection,nonunion and fracture fixation failure. Hip Harris score was 86.7±5.3 at the last follow-up,the result was excellent in 14 cases,good in 12 cases. Conclusion: Dimensional CT can be very good to predict the fracture of the irreducible femoral intertrochanteric fracture. Closed poking reduction and intramedullary nail fixation for the treatment of the irreducible femoral intertrochanteric fracture has satisfactory clinical result.