髓内钉内固定治疗高龄不稳定性股骨转子间骨折

目的 探讨髓内钉内固定治疗高龄不稳定性股骨转子间骨折的手术技术和疗效.方法 回顾性分析2014年7月-2015年12月期间采用髓内钉内固定治疗的64例高龄不稳定性股骨转子间骨折患者资料.其中男21例,女43例;年龄75～96岁,平均(81.9士5.2)岁;AO分型:31-A2.2型31例,31-A2.3型23例,31-A3.3型10例.根据复位方式,分为有限切开或器械辅助复位组(n=19)和直接闭合复位组(n=45).所有患者均采用髓内钉内固定治疗.比较两组患者手术耗时、术中出血量、骨折愈合时间以及末次随访时髋关节Harris评分.结果 有限切开器械辅助复位成功组患者术中出血量(365.8士81.2)mL]多于直接闭合复位组(238.9士56.7)mL],手术时间(93.4±10.4) vs (79.4±12.7) min]也较长,差异均有统计学意义(P＜0.05).随访12～18个月,两组患者骨折愈合时间(17.4±3.1) vs (16.7士2.2)周]及末次随访时髋关节Harris评分(84.7±8.3 vs 86.4±7.4)差异均无统计学意义(P＞0.05),两组均无深部感染、股骨头缺血坏死、髋内翻畸形、股骨干骨折及内置物失效、断裂等并发症发生.结论 不稳定股骨转子间骨折在高龄患者中并不少见,闭合复位困难时需要采用有限切开器械辅助复位以提高复位质量.虽然这会明显增加术中出血量和手术耗时,但并不影响临床整体疗效.

Intramedullary nail fixation in treatment of unstable femoral intertrochanteric fractures in elderly patients

Objective To explore the surgical technique and efficacy of intramedullary nails fixation in treatment of unstable femoral intertroehanteric fracture in elderly patients. Methods We retrospectively analyzed the data of 64 elderly patients with unstable intertrochanteric fractures who were treated with intramedullary nail fixation in our department from Jul. 2014 to Dec. 2015. There were 21 males and 43 females, with a mean age of (81.9±5.2) years old, ranging from 75 to 96 years. Thirty-one cases were type 31-A2.2, 23 were type 31-A2.3, and 10 were type 31-A3.3 according to AO classification.All patients were treated with intramedullary nail fixation and were divided into Group 1 (limited open reduction and temporary fixation by accessory appliances, n=19) and Group 2 (direct close reduction and fixation, n=45). The operation time, intraoperative blood loss, follow-up and fracture healing time, and Harris score of the hip at the last follow-up of patients were compared between the two groups. Results Compared with the Group 2, the intraoperative blood loss in the Group 1 was significantly higher (365.8±81.2] mL vs 238.9±56.7] mL, P<0.05) and the operation time was significantly longer (93.4±10.4] min vs 79.4±12.7] min, P<0.05). All patients were followed up for 12 to 18 months. There were no significant differences in the fracture healing time (17.4±3.1] weeks vs 16.7±2.2] weeks) or the Harris score at the last follow-up (84.7±8.3 vs 86.4±7.4) between the two groups (P>0.05). There were no complications such as deep infection, avascular necrosis of the femoral head, hip varus deformity, femoral shaft fractures, implant failure or fracture in the two groups. Conclusion Unstable femoral intertrochanteric fractures is common in elderly patients. The limited open reduction combined with temporary fixation by accessory appliances is required for good reduction when the closed reduction is hard to reset. Although the technique will greatly increase intraoperative blood loss and operation time, it does not affect the overall clinical effectiveness.