摘要
目的对髓内钉治疗股骨转子下骨折失败原因回顾性分析,探讨避免并发症的方法。方法 2006年1月至2012年1月,我科共收治闭合性股骨转子下骨折病人82例,内固定失败患者7例,其中男2例,女5例;年龄52～79岁,平均65岁。均为闭合性脆性骨折,X线提示均有中到重度骨质疏松症。按骨折类型:AO分型A1型2例,A3型1例,B2型2例,B3型1例,C1型1例;SeinsheimerⅡC型2例,ⅢA型3例,Ⅳ型1例,Ⅴ型1例。均采用微创闭合复位下髓内钉固定术。结果术后失败原因包括骨折内翻畸形2例,拉力螺钉切割股骨头4例,骨折远端向内侧移位2例;术后未负重出现内固定失败5例,负重后出现内固定失败2例。结论采用髓内固定时,术中仍应注重股骨内侧皮质稳定性,术后应根据骨折类型、股质量、骨愈合等情况作预防性措施。
Objective To investigate the causes of failure in using proximal femoral intramedullary nails for subtrochanteric fractures.Methods A total of 82 cases of the closed subtrochanteric fractures from Jan 2006 to Jan 2012 were treated with proximal femoral intramedullary nails fixation,and 7 of 82 cases were failed in fixation,including 2 males and 5 femals with an average age of 65 years(range from 52-79 years).X-ray examination indicated those moderate to severe osteoporosis.The pattern of the fractures included AO 32-A1 type in 2 cases,A3 type 1 cases,B2 type 2 cases,B3 type 1 cases,C1 type 1 cases,and Seinsheimer IIC type in 2 cases,Ⅲ A type 3 cases,Ⅳ type 1 cases,V type 1 cases.Result The pattern of failure of internal fixation included varus deformity of fracture in 2 cases,cut out of the lag screw from the femoral head in 4 cases and redisplacement of distal femoral fractures in 2 cases.Five cases occurred before weight-bearing and 2 cases after weight-bearing.Conclusion The femoral cortical stability still should be paid attention to proximal femoral intramedullary nails fixation in the operative procedure of the closed subtrochanteric fractures.
出处
《岭南现代临床外科》
2012年第6期457-459,472,共4页
Lingnan Modern Clinics in Surgery
基金
广东省医学科研基金项目(A2009512)
关键词
髓内钉
股骨
粗隆下
骨折
内固定
Intramedullary nail
Femur
Subtrochanteric of femur
Fracture
Internal fixation
