Sun Qi, Li Gen, Ge Wei, Lu Guanghua, Cai Ming, Li Shaohua
Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, 200072, P.R.China.
Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, 200072,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Sep 15;31(9):1043-1048. doi: 10.7507/1002-1892.201702069.
To discuss the effectiveness of intramedullary nail fixation with selective cable wiring in the treatment of ipsilateral femoral neck fracture and subtrochanteric fracture.
Between June 2012 and December 2015, a total of 19 patients with ipsilateral femoral neck fracture and subtrochanteric fracture underwent closed reduction of femoral neck fracture and intramedullary nail fixation combined with selective cable wiring. There were 5 males and 14 females with a median age of 52 years (range, 35-77 years). The cause of injury included traffic accident injury in 17 cases and falling injury in 2 cases. According to Garden classification for femoral neck fractures, 7 cases were rated as type Ⅱ, 8 as type Ⅲ, and 4 as type Ⅳ. Femoral subtrochanteric fractures were classified by Seinsheimer classification, with 9 cases as type Ⅱ, 5 as type Ⅲ, 3 as type Ⅳ, and 2 as type V. The interval from injury to operation ranged from 2 to 7 days with an average of 3.7 days.
The operation time was 58-125 minutes (mean, 82.4 minutes) and the intraoperative blood loss was 225-725 mL (mean, 289.5 mL). All incisions achieved healing by first intention and no early complication such as infection was observed. All patients were followed up 12-18 months (mean, 13.9 months). At 1 month after operation, the tip apex distance was 9-23 mm (mean, 15.2 mm). All patients achieved bone union with the healing time of 18-42 weeks (mean, 27.4 weeks). One case of hip varus and femoral neck re-displacement (femoral neck shaft angle was 122°) occurred at 3 months after operation, which achieved bone union at 42 weeks after operation. Five patients complained of postoperative pain with the visual analogue scale (VAS) score of 1-3 (mean, 1.8), which did not influence normal life. A total of 16 patients recovered preoperative hip function. During follow-up, no fracture nonunion, femoral head necrosis, implant failure, screw cut-out, and loosening of cable wiring was observed. The Harris hip score (HSS) was 72-92 (mean, 82.8) at last follow-up and 15 patients (78.9%) achieved good hip function.
Intramedullary nail fixation combined with selective cable wiring was effective in the treatment of ipsilateral femoral neck fracture and subtrochanteric fracture.
探讨髓内钉固定联合选择性缆线固定治疗同侧股骨颈骨折和转子下骨折的疗效。
2012年6月至2015年12月，共有19例同侧股骨颈骨折和转子下骨折患者接受了股骨颈骨折闭合复位、髓内钉固定联合选择性缆线固定。其中男性5例，女性14例，中位年龄52岁（范围35 - 77岁）。受伤原因包括交通事故伤17例，摔伤2例。根据股骨颈骨折Garden分型，Ⅱ型7例，Ⅲ型8例，Ⅳ型4例。股骨转子下骨折按Seinsheimer分型，Ⅱ型9例，Ⅲ型5例，Ⅳ型3例，Ⅴ型2例。受伤至手术时间为2 - 7天，平均3.7天。
手术时间为58 - 125分钟（平均82.4分钟），术中出血量为225 - 725毫升（平均289.5毫升）。所有切口均一期愈合，未观察到感染等早期并发症。所有患者均获随访12 - 18个月（平均13.9个月）。术后1个月时，尖顶距为9 - 23毫米（平均15.2毫米）。所有患者均达到骨愈合，愈合时间为18 - 42周（平均27.4周）。术后3个月出现1例髋内翻及股骨颈再次移位（股骨颈干角为122°），术后42周达到骨愈合。5例患者主诉术后疼痛，视觉模拟评分（VAS）为1 - 3分（平均为1.8分），未影响正常生活。共有16例患者恢复至术前髋关节功能。随访期间，未观察到骨折不愈合、股骨头坏死、植入物失败、螺钉穿出及缆线松动。末次随访时Harris髋关节评分（HSS）为72 - 92分（平均82.8分），15例患者（78.9%）髋关节功能良好。
髓内钉固定联合选择性缆线固定治疗同侧股骨颈骨折和转子下骨折疗效确切。
