Department of Clinical Medicine, Jining Medical University, 133 Hehua Road, Taibai Lake New District, Jining, 272067, Shandong, People's Republic of China.
Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Taibai Lake New District, Jining, 272007, Shandong, People's Republic of China.
J Orthop Surg Res. 2023 Mar 4;18(1):167. doi: 10.1186/s13018-023-03641-8.
To investigate the efficacy of the minimally invasive clamp reduction technique via the anterior approach in the treatment of irreducible intertrochanteric femoral fractures.
From January 2015 to January 2021, 115 patients (48 males and 67 females) with irreducible intertrochanteric femoral fractures were treated. The average age of the patients was 78.7 (45-100 years old). The types of injuries were falls (91 cases), traffic accidents (12 cases), smashing (6 cases), and high falling (6 cases). The duration between injury and surgery ranged from 1 to 14 days, with an average of 3.9 days. The distribution of AO classification was as follows: 31-A1 in 15 cases, type 31-A2 in 67 cases and 31-A3 in 33 cases.
All patients achieved good reduction, with fracture reduction times ranging from 10 to 32 min (mean of 18 min), and were followed up for 12-27 months after surgery (mean of 17.9 months). Two patients with pronation displacement of the proximal fracture segment died of infection or hypostatic pneumonia after internal fixation failure; one patient with failed internal fixation switched to joint replacement. After internal fixation, the lateral wall of six reversed intertrochanteric femoral fractures showed repronation and abduction displacement, but all fractures achieved bony healing. The rest of the patients did not lose fracture reduction, and all fractures achieved bony healing with a healing time ranging from 3 to 9 months (mean of 5.7 months). While two patients died and one patient exhibited failed internal fixation and thus switched to joint replacement, 91 of the remaining 112 patients had an excellent Harris score of the hip joint function at the final follow-up, while 21 patients had a good Harris score.
The minimally invasive clamp reduction technique via the anterior approach for the treatment of irreducible intertrochanteric femoral fractures is simple, effective and minimally invasive. In the case of irreducible intertrochanteric femoral fractures associated with lateral wall displacement, the lateral wall needs to be strengthened after clamp reduction and intramedullary nail fixation to avoid loss of reduction and failure of internal fixation.
探讨经前路微创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 2021 年 1 月，治疗 115 例难复性股骨转子间骨折患者，男 48 例，女 67 例；年龄 45～100 岁，平均 78.7 岁。致伤原因：摔伤 91 例，交通伤 12 例，砸伤 6 例，高处坠落伤 6 例。受伤至手术时间 1～14 d，平均 3.9 d。AO 分型：31-A1 型 15 例，31-A2 型 67 例，31-A3 型 33 例。
所有患者均获得良好复位，骨折复位次数 10～32 min，平均 18 min。术后随访 12～27 个月，平均 17.9 个月。2 例因内固定失败出现近段骨折块旋转移位死亡，1 例因内固定失败改行关节置换。内固定后，6 例反转子间骨折外侧壁出现再旋转移位、外展移位，但均骨性愈合。其余患者未丢失骨折复位，均骨性愈合，愈合时间 3～9 个月，平均 5.7 个月。2 例死亡，1 例因内固定失败改行关节置换。112 例获随访患者中，91 例髋关节功能 Harris 评分优，21 例良。
经前路微创夹复位技术治疗难复性股骨转子间骨折操作简单、有效，微创。对于合并外侧壁移位的难复性股骨转子间骨折，夹复位、髓内钉固定后需要加强外侧壁，避免复位丢失和内固定失败。
