Zhao Yifeng, Jiang Zhen, Li Tao, Xu Chongyang, Han Liang, Chu Fenglong, Wu Bin, Gao Ming, Wang Haibin
Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China.
Department of Orthopedics, Wenshang People's Hospital, Jining Shandong, 272501, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021 May 15;35(5):544-549. doi: 10.7507/1002-1892.202012030.
To explore the effectiveness of minimally invasive clamp reduction technique via anterior approach in treatment of irreducible intertrochanteric femoral fractures.
Between January 2015 and January 2019, 59 patients with irreducible intertrochanteric femoral fractures were treated with minimally invasive clamp reduction technique via anterior approach. There were 29 males and 30 females with an average age of 77.9 years (range, 45-100 years). The causes of injury included falling in 46 cases, traffic accident in 6 cases, smashing in 2 cases, and falling from height in 5 cases. The time from injury to operation was 1-14 days (mean, 3.8 days). The fractures were classified as AO type 31-A1 in 12 cases, type 31-A2 in 25 cases, type 31-A3 in 22 cases.
All fractures were reduced well and the fracture reduction took 10 to 30 minutes, with an average of 19 minutes. All patients were followed up 13-25 months, with an average of 17.6 months. Among them, 2 cases of pronation displacement of proximal fracture segment died for infection or falling pneumonia after internal fixation failed. Six patients with reversed intertrochanteric femoral fractures experienced re-pronation and abduction displacement of the lateral wall after internal fixation, but the fractures all healed. The rest of the patients had no fracture reduction loss, and the fractures healed with an average healing time of 5.9 months (range, 3-9 months). Except for 2 patients who died, the Harris score of hip joint function of the remaining 57 patients was excellent in 49 cases and good in 8 cases at last follow-up.
The minimally invasive clamp reduction technique via anterior approach for irreducible intertrochanteric femoral fractures is simple and effective. For irreducible intertrochanteric femoral fractures related to lateral wall displacement, after clamp reduction and intramedullary nail fixation, the lateral wall should be reinforced in order to avoid reduction loss and internal fixation failure.
探讨经前路微创钳夹复位技术治疗难复性股骨转子间骨折的疗效。
2015年1月至2019年1月，采用经前路微创钳夹复位技术治疗59例难复性股骨转子间骨折患者。其中男29例，女30例，平均年龄77.9岁（范围45 - 100岁）。受伤原因包括跌倒46例、交通事故6例、砸伤2例、高处坠落5例。受伤至手术时间为1 - 14天（平均3.8天）。骨折按AO分型：31 - A1型12例，31 - A2型25例，31 - A3型22例。
所有骨折均复位良好，骨折复位时间为10 - 30分钟，平均19分钟。所有患者均获随访13 - 25个月，平均17.6个月。其中，2例近端骨折段旋前移位患者内固定失败后因感染或坠积性肺炎死亡。6例反转子间骨折患者内固定后出现外侧壁再次旋前及外展移位，但骨折均愈合。其余患者无骨折复位丢失，骨折平均愈合时间为5.9个月（范围3 - 9个月）。除2例死亡患者外，其余57例患者末次随访时髋关节功能Harris评分优49例，良8例。
经前路微创钳夹复位技术治疗难复性股骨转子间骨折简便有效。对于合并外侧壁移位的难复性股骨转子间骨折，钳夹复位髓内钉固定后应加强外侧壁，以避免复位丢失及内固定失败。
