Yao Xiaoke, Wu Lingna, Li Jianhua, Huang Wengang, Duan Xin, Gu Zuchao, Wang Yue
Department of Orthopedics, Chengdu First People's Hospital, Chengdu Sichuan, 610041, P.R.China.
Department of Intensive Care Unit, Chengdu First People's Hospital, Chengdu Sichuan, 610041, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020 Apr 15;34(4):457-462. doi: 10.7507/1002-1892.201908100.
To investigate the effectiveness of closed or limited open reduction and intramedullary nail fixation in the treatment of Seinsheimer type Ⅴ subtrochanteric fracture.
Between May 2014 and July 2018, 36 patients with Scinsheimer type Ⅴ subtrochanteric fractures were treated with closed or limited open reduction and intramedullary nail fixation. There were 25 males and 11 females with an age of 23-86 years (mean, 55.8 years). The cause of injury included falling in 19 cases, traffic accident in 9 cases, falling from height in 7 cases, and heavy object injury in 1 case; all were fresh closed injuries. The interval between injury and operation was 1-14 days (mean, 6.8 days). There were 18 cases of closed reduction and 18 cases of limited open reduction during the operation. Seventeen cases were fixed with femoral reconstruction intramedullary nail, 5 with InterTan long nail, 14 with lengthened proximal femoral nail anti-rotation, and 7 cases were assisted with auxiliary steel wire binding. After operation, through X-ray film and clinical follow-up, the fracture reduction and maintenance status, internal fixation position, and fracture healing were judged; the range of motion, walking ability, and complications of hip joint were observed, and the function of hip joint was evaluated according to Merle d'Aubigne Postel hip joint scoring standard.
All the incisions of medullary operation healed by first intention, and no vascular, nerve injury, or infection occurred. All patients were followed up 12-24 months, with an average of 14.2 months. Among the 36 patients, 1 patient received revision surgery due to varus displacement of femoral head and screw penetration at 2 months after closed reduction, with poor recovery of hip function. X-ray film re-examination showed that the fractures of the other 35 patients healed after 9-15 months, with an average of 11.5 months. During follow-up, there was no complication such as internal fixation failure, fracture redisplacement, bone nonunion or malunion, and deep vein thrombosis of lower extremity occurred. The function of hip joint recovered well, and the patients could walk and squat normally without affecting daily life or work. At last follow-up, according to Merle d'Aubigne Postel hip joint scoring standard, 28 cases were rated as excellent, 4 cases as good, 3 cases as fair, and 1 case as poor, the excellent and good rate was 88.9%.
C-arm X-ray fluoroscopic closed or limited open reduction and intramedullary nail fixation for the treatment of Seinheimer Ⅴ type subtrochanteric fracture, if necessary, with the aid of auxiliary steel wire binding, it has the advantages of less blood supply destruction at the fracture end, satisfactory reduction, firm fixation, and early rehabilitation training, with definite effectiveness.
探讨闭合或有限切开复位髓内钉固定治疗SeinsheimerⅤ型股骨转子下骨折的疗效。
2014年5月至2018年7月，对36例SeinsheimerⅤ型股骨转子下骨折患者采用闭合或有限切开复位髓内钉固定治疗。其中男性25例，女性11例，年龄23 - 86岁（平均55.8岁）。致伤原因包括跌倒19例、交通事故9例、高处坠落7例、重物砸伤1例；均为新鲜闭合伤。受伤至手术时间为1 - 14天（平均6.8天）。术中闭合复位18例，有限切开复位18例。采用股骨重建髓内钉固定17例，InterTan长钉固定5例，加长型股骨近端抗旋髓内钉固定14例，7例辅助钢丝捆绑。术后通过X线片及临床随访，判断骨折复位及维持情况、内固定位置及骨折愈合情况；观察髋关节活动范围、行走能力及并发症，根据Merle d'Aubigne Postel髋关节评分标准评估髋关节功能。
所有髓内手术切口均一期愈合，未发生血管、神经损伤及感染。所有患者均获随访12 - 24个月，平均14.2个月。36例患者中，1例闭合复位术后2个月因股骨头内翻移位及螺钉穿出接受翻修手术，髋关节功能恢复差。X线片复查显示，其余35例患者骨折于9 - 15个月愈合，平均11.5个月。随访期间未发生内固定失败、骨折再移位、骨不连或畸形愈合等并发症，未发生下肢深静脉血栓形成。髋关节功能恢复良好，患者可正常行走及下蹲，不影响日常生活及工作。末次随访时，根据Merle d'Aubigne Postel髋关节评分标准，优28例，良4例，可3例，差1例，优良率为88.9%。
C型臂X线透视下闭合或有限切开复位髓内钉固定治疗SeinheimerⅤ型股骨转子下骨折，必要时辅助钢丝捆绑，具有骨折端血运破坏少、复位满意、固定牢固、可早期康复训练等优点，疗效确切。
