| 孔 波,孙清国,张 威.内侧皮质不同复位等级对股骨转子间骨折髓内钉内固定术后临床疗效的影响[J].中国烧伤创疡杂志,2022,(4):262~266. |
| DOI： |
| 中文关键词: 股骨转子间骨折 髓内钉内固定 内侧皮质 正性支撑复位 稳定性 |
| 英文关键词:Femoral intertrochanteric fracture Intramedullary nailing Medial cortical supports Positive buttress reduction Stability |
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| 中文摘要: |
| 【摘要】 目的 探究内侧皮质不同复位等级对股骨转子间骨折 (FIF) 股骨近端髓内钉内固定术后临床疗效的影响。 方法 选取2016年6月至2019年10月正阳县人民医院收治的76 例FIF患者作为研究对象，并根据股骨近端髓内钉内固定术后即刻正位 X 线片显示的头颈骨块内侧皮质和股骨干内侧皮质的位置关系将患者分为正性支撑组(25例)、中性支撑组 (26例)和负性支撑组(25例)，其中正性支撑组患者头颈骨块内侧皮质位于股骨干内侧皮质内上方，中性支撑组患者头颈骨块内侧皮质与股骨干内侧皮质影像学上完全对位，负性支撑组患者头颈骨块内侧皮质位于股骨干内侧皮质外上方。 对比观察 3 组患者术中出血量、手术时间、术后即刻尖顶距(TAD)、骨折愈合时间、股骨颈长度及颈干角变化情况以及临床疗效与并发症发生情况。结果 3 组患者术中出血量、手术时间及术后即刻 TAD 无明显差异 (F =0.021、0.015、0.255，P =0.980、0.985、0.880)。 正性支撑组患者骨折愈合时间明显短于负性支撑组 (q =5.373，P <0.001)，而正性支撑组和中性支撑组、中性支撑组和负性支撑组间无明显差异 (q =3.145、2.280，P = 0.074、0.246)。术后即刻及术后3个月，正性支撑组患者股骨颈长度均明显长于中性支撑组和负性支撑组(术后即刻: q =6.172、13.920，P 均 <0.001；术后 3 个月: q =16.240、30.600，P 均 < 0.001)，且中性支撑组患者股骨颈长度明显长于负性支撑组 (q = 7.887、14.660，P均<0.001)；正性支撑组患者颈干角均明显大于中性支撑组和负性支撑组 (术后即刻: q = 3.562、7.839，P =0.037、P <0.001；术后 3 个月: q =12.360、24.860，P 均 <0.001)，且中性支撑组患者颈干角明显大于负性支撑组 (q =4.353、12.740，P =0.008、P <0.001)。 术后 6 个月，正性支撑组患者中优 15 例、良 8 例、中 1 例?差 1 例，明显优于中性支撑组患者的优8例、良8例、中7例、差3例以及负性支撑组患者的优 6 例、良 7 例?中 6 例、差6例 (Z = - 2.520、- 3.150，P = 0.012、0.002)，而中性支撑组与负性支撑组间无明显差异(Z = -0.917，P =0.359)。正性支撑组患者术后并发症发生率为 4.00%，中性支撑组患者术后并发症发生率为23.08%，负性支撑组患者术后并发症发生率为 28.00%，3 组患者并发症发生情况无明显差异 (χ2 =5.361，P =0.069)。 结论 FIF患者髓内钉内固定术后内侧皮质正性支撑复位稳定性更好，可明显缩短骨折愈合时间，改善股骨颈长度及颈干角，临床疗效较好，术中有意识的获得正性支撑复位非常必要。 |
| 英文摘要: |
| 【Abstract】 Objective To investigate the influence of reduction with different medial cortical supports on the clinical efficacy of intramedullary nailing at proximal femur for femoral intertrochanteric fracture (FIF). Methods 76 patients with FIF, admitted into Zhengyang People’s Hospital between June 2016 and October 2019, were enrolled as research subjects, and divided into positive buttress group (n = 25), anatomic reduction group (n = 26) and negative buttress group (n =25) based on the positional relation between proximal fracture fragment (femoral neck and head) and distal femoral neck fragment from the anteroposterior view of X ray immediately after the intramedullary nailing at proximal femur. In positive buttress group, the proximal fracture fragments of patients were displaced medially to the upper medial edge of the distal femoral neck fragment; in anatomic reduction group, the proximal fracture fragment of patients were positioned exactly into the medial edge of the distal femoral neck fragments based on imaging, while in negative buttress group, the distal femoral neck fragments of patients were positioned medially to the lowermedial edge of the proximal fracture fragments. Intraoperative blood loss, operation time, tip apex distance (TAD) immediately after surgery, fracture healing time, changes of femoral neck length and neck shaft angle, clinical efficacy and occurrence of complications were compared among the three groups. Results The intraoperative blood loss, operation time and TAD immediately after surgery presented no significant differences among the three groups (F = 0.021, 0.015 and 0.255, P = 0.980, 0.985 and 0.880). The fracture healing time was obviously shorter in positive buttress group than negative buttress group (q =5.373, P <0.001), while no significant difference was observed respectively between positive buttress group and anatomic reduction group, and between anatomic reduction group and negative buttress group (q =3.145 and 2.280, P =0.074 and 0.246). Immediately after surgery and 3 months after surgery, the femoral neck lengths of patients were markedly longer in positive buttress group than the other two groups (immediately after surgery: q = 6.172 and 13.920, both P < 0.001; 3 months after surgery: q = 16.240 and 30.600, both P <0.001), and the femoral neck lengths were obviously longer in anatomic reduction group than negative buttress group (q =7.887 and 14.660, both P < 0.001); the neck shaft angles were obviously larger in positive buttress group compared with the other two groups (immediately after surgery: q = 3.562 and 7.839, P = 0.037, P < 0.001; 3 months after surgery: q = 12.360 and 24.860, both P < 0.001), and the neck shaft angles in anatomic reduction group were markedly larger than that in negative buttress group (q =4.353 and 12.740, P =0.008, P <0.001). Six months after surgery, the clinical efficacy was evaluated as excellent in 15 cases, good in 8 cases, fair in 1 case and poor in 1 case in positive buttress group, much better than anatomic reduction group-excellent in 8 cases, good in 8 cases, fair in 7 cases and poor in 3 cases, and negative buttress group-excellent in 6 cases, good in 7 cases, fair in 6 cases and poor in 6 cases (Z = -2.520 and -3.150, P =0.012 and 0.002), while there was no significant difference between anatomic reduction group and negative buttress group (Z = -0.917, P =0.359). The incidence of postoperative complications was 4.00% in positive buttress group, 23.08% in anatomic reduction group and 28.00% in negative buttress group, and no significant difference was observed among the three groups (χ2 =5.361, P=0.069). Conclusion In FIF patients after the intramedullary nail fixation, the positive buttress reduction, presenting better stability, can significantly shorten the fracture healing time, ameliorate femoral neck length and neck shaft angle, and achieve good clinical efficacy. It is of necessity to deliberately realize the positive buttress reduction during the operation. |
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