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范振宇,丁晨,葛鑫宇,纪方,唐昊*.远端第四点固定因素在髓内钉治疗不稳定型股骨粗隆间骨折中的作用[J].Academic Journal of Second Military Medical University ,2020,41(1):18-23
远端第四点固定因素在髓内钉治疗不稳定型股骨粗隆间骨折中的作用    点此下载全文 Fulltext
范振宇  丁晨  葛鑫宇  纪方  唐昊*
长海医院创伤骨科, 上海 200433
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      目的 回顾性分析髓内钉治疗不稳定型股骨粗隆间骨折的临床疗效,评价远端第四点固定因素在其中的作用。方法 选择2014年6月至2018年6月于海军军医大学(第二军医大学)长海医院接受治疗的国际内固定研究协会(AO)分型为A2.2~A3.3的不稳定型股骨粗隆间骨折患者108例。根据手术方法将患者分为3组:短髓内钉髓腔匹配组(42例)、短髓内钉髓腔不匹配组(40例)、长髓内钉组(26例)。比较3组的手术时间、术中出血量、骨折愈合时间、术后并发症及疗效,其中疗效评价采用Harris髋关节功能评分标准。结果 短髓内钉髓腔匹配组、短髓内钉髓腔不匹配组、长髓内钉组患者年龄、性别构成、致伤原因构成的差异均无统计学意义(P均>0.05),3组患者的骨折AO分型存在差异(P<0.01)。短髓内钉髓腔匹配组手术时间为(62.26±31.03)min,短于长髓内钉组[(89.54±26.70)min],差异有统计学意义(P<0.05),与短髓内钉髓腔不匹配组[(64.53±29.22)min]相比差异无统计学意义(P>0.05);短髓内钉髓腔匹配组术中出血量为(149.19±45.97)mL,少于长髓内钉组[(230.77±57.40)mL],差异有统计学意义(P<0.05),与短髓内钉髓腔不匹配组[(153.43±40.30)mL]相比差异无统计学意义(P>0.05);短髓内钉髓腔不匹配组骨折愈合时间为(14.10±2.22)个月,长于短髓内钉髓腔匹配组、长髓内钉组[分别为(11.43±2.95)个月、(12.35±4.47)个月],差异均有统计学意义(P<0.05);末次随访时短髓内钉髓腔不匹配组Harris评分为(77.33±8.18)分,低于短髓内钉髓腔匹配组、长髓内钉组[分别为(85.52±10.76)分、(89.12±9.14)分],差异均有统计学意义(P<0.05)。短髓内钉髓腔匹配组2例患者出现髋内翻畸形,短髓内钉髓腔不匹配组8例患者出现术后复位丢失,长髓内钉组未出现术后并发症,3组间并发症发生率差异有统计学意义(Fisher确切概率检验,P=0.013)。结论 运用远端第四点固定技术可以减少不稳定型股骨粗隆间骨折术后复位的丢失及内固定失败等并发症,缩短骨折愈合时间,从而使患者早期负重锻炼。
关键词:股骨粗隆间骨折  不稳定型骨折  短髓内钉  长髓内钉  远端固定第四点因素
Role of the distal fourth fixation factor in treatment of unstable femoral intertrochanteric fractures with intramedullary nails    Fulltext
FAN Zhen-yu  DING Chen  GE Xin-yu  JI Fang  TANG Hao*
Department of Orthopaedic Trauma, Changhai Hospital, Naval Medical University(Second Military Medical University)
, Shanghai 200433, China
*Corresponding author
Fund Project:Supported by General Program of National Natural Science Foundation of China (81572637).
      Objective To investigate the role of the distal fourth fixation factor in the treatment of unstable femoral intertrochanteric fractures with intramedullary nails. Methods A total of 108 patients with unstable femoral intertrochanteric fractures (AO type:A2.2-A.3.3) treated from Jun. 2014 to Jun. 2018 in our hospital were selected and divided into three groups. The injury was fixed with short intramedullary nails and had matched medullary cavity in group A (n=42). The injury was fixed with short intramedullary nails and had mismatched medullary cavity in group B (n=40). The injury was fixed with long intramedullary nails in group C (n=26). Operation time, intraoperative blood loss, fracture healing time, postoperative complications and clinical efficacy were compared among the three groups. The efficacy was evaluated by the Harris hip score. Results There was no significant difference in the age, gender composition, or causes of injury between groups (P>0.05), but there was statistic difference in the AO type between groups (P<0.01). The operation time of group A was (62.26±31.03) min, which was significantly shorter than that of group C ([89.54±26.70] min, P<0.05), but not statistically different from group B ([64.53±29.22] min, P>0.05). The amount of intraoperative bleeding in group A was (149.19±45.97) mL, which was significantly less than that in group C ([230.77±57.40] mL, P<0.05), but not statistically different from group B ([153.43±40.30] mL, P>0.05). The fracture healing time in group B was (14.10±2.22) months, which was significantly longer than that in group A ([11.43±2.95] months) and group C ([12.35±4.47] months, P<0.05). At the last follow-up, the Harris score in group B was 77.33±8.18, which was significantly lower than that in group A and C (85.52±10.76, 89.12±9.14, P<0.05). Two patients in group A developed coxa vara. Eight patients had lost restoration in group B. No complications occurred in group C. There was significant difference in the incidence of complication among the three groups (Fisher exact test, P=0.013). Conclusion The technique using the distal fourth fixation factor can reduce the complications of unstable femoral intertrochanteric fractures such as postoperative loss of restoration and internal fixation failure, shorten the fracture healing time, and achieve early weight-bearing exercise.
Keywords:intertrochanteric fracture  unstable fracture  short intramedullary nail  long intramedullary nail  the distal fourth fixation factor
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