股骨大粗隆入钉点与梨状窝入钉点交锁髓内钉内固定治疗股骨干骨折的疗效对比研究

目的探讨股骨大粗隆入钉点与梨状窝入钉点交锁髓内钉内固定治疗股骨干骨折的疗效。方法回顾性分析2014年12月-2017年12月安庆市第一人民医院骨科收治的股骨干骨折患者80例,男性52例,女性28例;年龄23~44岁,平均31.5岁;BMI 19.8~24.7kg/m^2,平均22.11kg/m^2;致伤原因:道路交通伤38例,坠落伤29例,摔伤13例。根据髓内钉入钉点的不同将其分为大粗隆组和梨状窝组,其中大粗隆组43例,选用股骨大粗隆入钉点;梨状窝组37例,选用梨状窝入钉点。比较两组患者的围术期指标及骨折愈合时间,比较末次随访时两组患者的髋关节功能以及颈干角、股骨颈直径、股骨头最高点平面与股骨大粗隆顶点平面间距离(ATD),比较两组患者的术后并发症。结果两组患者的显性出血量(272.5±43.3)mL vs.(292.4±50.5)mL]、隐性出血量(1592.4±185.3)mL vs.(1667.5±192.2)mL]、骨折愈合时间(23.6±7.4)周vs.(23.9±6.8)周]比较,差异无统计学意义(P>0.05)。大粗隆组的手术时间为(68.5±12.3)min,短于梨状窝组的(81.2±18.6)min,差异有统计学意义(P<0.05);末次随访时,两组患者的髋关节功能优良率(93%vs.92%)、颈干角(131.97±5.36)°vs.(132.15±4.25)°]、股骨颈直径(33.54±4.27)mm vs.(33.81±4.53)mm]、ATD (27.45±4.31)mm vs.(27.68±4.19)mm]比较,差异无统计学意义(P>0.05)。两组患者术后均未出现严重的并发症。结论采用股骨大粗隆入钉点与梨状窝入钉点交锁髓内钉内固定治疗股骨干骨折均可获得良好的临床效果,且无明显的术后并发症,但股骨大粗隆入钉点操作更方便,手术时间更短。

A comparative study of the treatment of femoral shaft fractures with femoral trochanteric nail insertion point and piriform fossa incision interlocking intramedullary nail

Objective To investigate the effect of the treatment of femoral shaft fractures with femoral trochanteric nail insertion point and piriform fossa incision interlocking intramedullary nail.Methods Totally 80 cases of femoral shaft fracture who were treated in our hospital from Dec. 2014 to Dec. 2017 were analyzed.They were divided into large trochanter group and piriform fossa group according to different intramedullary nail insertion points.Among them,43 cases were in the large trochanter group,who were operated through femoral trochanteric nail insertion point. The other 37 cases were in the piriform fossa group,who were operated through piriform fossa insertion point.The perioperative index and fracture healing time of the two groups were compared.The hip function and neck shaft angle,femoral neck diameter and articulotrochanteric distance(ATD) were compared between the two groups at the last follow-up.The postoperative complications of the two groups were compared.Results There was no significant difference in the amount of dominant bleeding(272.5±43.3)mL vs.(292.4±50.5)mL],recessive bleeding(1592.4±185.3)mL vs.(1667.5±192.2)mL] and fracture healing time(23.6±7.4) weeks vs.(23.9±6.8) weeks] between the two groups(P>0.05).The operation time of the large trochanter group was(68.5±12.3) min,which was shorter than that of the piriform fossa group(81.2±18.6) min,and the difference was statistically significant(P<0.05).At the last follow-up,there was no significant difference in hip function excellence rate(93% vs. 92%),neck shaft angle (131.97±5.36)° vs.(132.15±4.25)°],femoral neck diameter (33.54±4.27)mm vs.(33.81±4.53)mm] and ATD (27.45±4.31)mm vs.(27.68±4.19)mm] between the two groups(P>0.05).There was no serious complication after operation in either group.Conclusion Both the femoral trochanteric nail insertion point and piriform fossa incision interlocking intramedullary nail can achieve good clinical results in the treatment of femoral shaft fractures,and there is no obvious postoperative complication,but the femoral trochanteric nail insertion point is more convenient,and the operation time is shorter.