Intertan髓内钉治疗股骨粗隆间骨折术中闭合复位丢失的临床研究
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摘要
目的分析Intertan髓内钉治疗股骨粗隆间骨折术中闭合复位丢失的相关因素并探讨相应对策。方法回顾2011年1月至2017年6月,我院采用Intertan髓内钉治疗股骨粗隆间骨折、术中闭合复位丢失59例,获得随访56例,死亡2例,失访1例。收集患者术前基本资料、术中指标、术后恢复情况。对所收集的资料进行统计学分析,数值变量用均数±标准差表示。结果骨折复位(例):正性内侧皮质支撑39,中性支撑10,负性支撑7。Harris评分平均85.7±9.86分。56例入钉点的位置分布(例):居中42;偏前3;偏后6;偏内1;偏外4例。出现移位的情况(例):入钉点位置14;螺纹针开口4,开口器开口8;开口钻钻入10;插入主钉8;拧入粗拉力螺钉6;拧入交锁螺钉6。结论 Intertan髓内钉可有效地治疗股骨粗隆间骨折。而掌握入钉点位置、开口方式、开口钻的方法、主钉及拉力螺钉的拧入方式等,能解决术中出现闭合复位丢失的现象。
Objective To analyse the related factors and corresponding counter-measures of loss of reduction during the operation in the treatment of intertrochanteric femoral fracture with intertan intramedullary nail. Methods It is a retrospective study in which 59 patients with intertrochanteric femoral fracture were treated by closed reduction with intertan fixation from Jan 2011 to Jun 2017. 56 cases were followed up, 2 cases died and 1 case dropped out.The general characteristic, intraoperative events and postoperative variable were collected for statistical analysis.The numerical variables were demonstrated as mean ± standard deviation. Results The reduction status of fracture were(case): positive medial cortex support 39, neutral position 10, negative medial cortex support 7. The average Harris score was 85.7±9.86. The distribution of Intertan entrance point(case) were: middle 42, anterior 3,posterior 6, medial 1, lateral 4. Loss of reduction occurred in the following procedures(case): nailing entrance14, screw thread opening 4, opener opening 8, reamer drilling 10, inserting main nail 8, screwing lag screw 6,screwing interlocking screw 6. Conclusion Intertan intramedullary nail can effectively treat intertrochanteric femoral fracture. Grasp the position of intertan entrance point, the method of opening, the drilling method of the opening,the method of screw and etc can solve the phenomenon of closed reduction loss during operation.
Objective To analyse the related factors and corresponding counter-measures of loss of reduction during the operation in the treatment of intertrochanteric femoral fracture with intertan intramedullary nail. Methods It is a retrospective study in which 59 patients with intertrochanteric femoral fracture were treated by closed reduction with intertan fixation from Jan 2011 to Jun 2017. 56 cases were followed up, 2 cases died and 1 case dropped out.The general characteristic, intraoperative events and postoperative variable were collected for statistical analysis.The numerical variables were demonstrated as mean ± standard deviation. Results The reduction status of fracture were(case): positive medial cortex support 39, neutral position 10, negative medial cortex support 7. The average Harris score was 85.7±9.86. The distribution of Intertan entrance point(case) were: middle 42, anterior 3,posterior 6, medial 1, lateral 4. Loss of reduction occurred in the following procedures(case): nailing entrance14, screw thread opening 4, opener opening 8, reamer drilling 10, inserting main nail 8, screwing lag screw 6,screwing interlocking screw 6. Conclusion Intertan intramedullary nail can effectively treat intertrochanteric femoral fracture. Grasp the position of intertan entrance point, the method of opening, the drilling method of the opening,the method of screw and etc can solve the phenomenon of closed reduction loss during operation.
引文
[1]Takemoto RC,Lekic N,Schwarzkopf R,et al.The effect of two different trochanteric nail lag-screw designs on fixation stability of four-part intertrochanteric fractures:a clinical and biomechanica study[J].J Orthop Sci,2014,19(1):112-119.
[2]Rupprecht M,Grossterlinden L,Ruecker AH,et al.A comparative biomechanical analysis of fixation devices for unstable femora neck fractures:the Intertan versus cannulated screws or a dynamic hip screw[J].J Trauma,2011,71(3):625-634.
[3]Rupprecht M,Grossterlinden L,Sellenschloh K,et al.Internal fixation of femoral neck fractures with posterior comminution:a biomechanical comparison of DHS?and Intertan nail?[J].IntOrthop,2011,35(11):1695-1701.
[4]Aktselis I,Kokoroghiannis C,Fragkomichalos E,et al.Prospective randomised controlled trial of an intramedullary nail versus a sliding hip screw for intertrochanteric fractures of the femur[J].Int Orthop,2014,38(1):155-161.
[5]Berger-Groch J,Rupprecht M,Schoepper S,et al.Five-Year Outcome Analysis of Intertrochanteric Femur Fractures:A Prospective R andomized Trial Comparing a 2-Screw and a Single-Screw Cephalomedullary Nail[J].J Orthop Trauma,2016,30(9):483-488.
[6]吴鹏,范步新,贾金生,等.两种头髓型内固定系统治疗不稳定型股骨粗隆间骨折的回顾性分析[J].生物骨科材料与临床研究,2013,10(1):40-43.
[7]吴鹏,范步新,甘立猛,等.股骨粗隆间骨折术后并发症及原因分析[J].生物骨科材料与临床研究,2015,12(1):36-38.
[8]王波,吴鹏,刘长松,等.股骨粗隆间骨折手术并发症分析[J].实用骨科杂志,2016,22(12):1124-1127.
[2]Rupprecht M,Grossterlinden L,Ruecker AH,et al.A comparative biomechanical analysis of fixation devices for unstable femora neck fractures:the Intertan versus cannulated screws or a dynamic hip screw[J].J Trauma,2011,71(3):625-634.
[3]Rupprecht M,Grossterlinden L,Sellenschloh K,et al.Internal fixation of femoral neck fractures with posterior comminution:a biomechanical comparison of DHS?and Intertan nail?[J].IntOrthop,2011,35(11):1695-1701.
[4]Aktselis I,Kokoroghiannis C,Fragkomichalos E,et al.Prospective randomised controlled trial of an intramedullary nail versus a sliding hip screw for intertrochanteric fractures of the femur[J].Int Orthop,2014,38(1):155-161.
[5]Berger-Groch J,Rupprecht M,Schoepper S,et al.Five-Year Outcome Analysis of Intertrochanteric Femur Fractures:A Prospective R andomized Trial Comparing a 2-Screw and a Single-Screw Cephalomedullary Nail[J].J Orthop Trauma,2016,30(9):483-488.
[6]吴鹏,范步新,贾金生,等.两种头髓型内固定系统治疗不稳定型股骨粗隆间骨折的回顾性分析[J].生物骨科材料与临床研究,2013,10(1):40-43.
[7]吴鹏,范步新,甘立猛,等.股骨粗隆间骨折术后并发症及原因分析[J].生物骨科材料与临床研究,2015,12(1):36-38.
[8]王波,吴鹏,刘长松,等.股骨粗隆间骨折手术并发症分析[J].实用骨科杂志,2016,22(12):1124-1127.