Xu Zhiyang, Zhang Mei, Yin Jian, Ren Longxi, Zeng Yanjun
Department of Orthopaedics, Chuiyangliu Hospital of Beijing, Beijing, 100022, China,
Arch Orthop Trauma Surg. 2015 Jun;135(6):751-8. doi: 10.1007/s00402-015-2205-y. Epub 2015 Mar 26.
During the implantation of intramedullary nail in surgery of intertrochanteric fracture, the fact that the originally satisfactory reduction may incur redisplacement remains a major concern. In this article, we will analyze the reasons of redisplacement and describe some methods that can improve the quality of reduction.
From January 2012 to October 2014, 67 patients with intertrochanteric fracture were treated using Gamma3 or PFNA system. All the surgical procedures were monitored by fluoroscopy on the AP and lateral views, and the X-ray films were used to evaluate all cases.
Redisplacement occurred in ten cases intraoperatively. According to the fracture type, re-occurring deformities appeared in 31-A2 and 31-A3 commonly, 6 and 3 cases. We found the redisplacement emerged usually in operative procedure and some manipulations should be taken to obtain an anatomic reduction.
When reduction is achieved in the surgery of intertrochanteric fracture, surgeons tend to overlook the occurrence of redisplacement, or not to treat it that has emerged timely. Internal fixation in nonanatomic reduction may increase the likelihood of fixation failure postoperatively. For the importance of accurate reduction of the fracture, once redisplacement occurs during the surgery, some methods or tricks are applicable to it to restore the anatomic reduction.
在股骨转子间骨折手术中髓内钉植入过程中，最初复位满意却可能出现再移位这一情况仍是主要关注点。在本文中，我们将分析再移位的原因并描述一些可提高复位质量的方法。
2012年1月至2014年10月，67例股骨转子间骨折患者采用Gamma3或PFNA系统治疗。所有手术操作均在透视下进行前后位和侧位监测，并用X线片评估所有病例。
术中10例出现再移位。根据骨折类型，31 - A2和31 - A3型骨折再发畸形常见，分别为6例和3例。我们发现再移位通常出现在手术过程中，应采取一些操作以获得解剖复位。
在股骨转子间骨折手术中实现复位后，外科医生往往忽视再移位的发生，或未及时处理已出现的再移位。非解剖复位的内固定可能增加术后固定失败的可能性。鉴于骨折精确复位的重要性，一旦手术中发生再移位，一些方法或技巧可用于恢复解剖复位。
