[1]翟生* 吕青 丁路.侧卧位髓内钉联合钛缆环扎治疗股骨转子下骨折[J].中国微创外科杂志,2021,01(5):454-458.
　Zhai Sheng,Lv Qing,Ding Lu..Lateral Decubitus Position Intramedullary Nail Combined With Titanium Cable Cerclage in the Treatment of Femoral Subtrochanteric Fracture[J].Chinese Journal of Minimally Invasive Surgery,2021,01(5):454-458.
点击复制

侧卧位髓内钉联合钛缆环扎治疗股骨转子下骨折()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2021年5期
页码:
454-458
栏目:
经验交流
出版日期:
2021-05-25

文章信息/Info

Title:
Lateral Decubitus Position Intramedullary Nail Combined With Titanium Cable Cerclage in the Treatment of Femoral Subtrochanteric Fracture
作者:
翟生* 吕青 丁路
（新疆医科大学第五附属医院骨一科，乌鲁木齐830011）
Author(s):
Zhai Sheng;  Lv Qing;  Ding Lu.
Department of Orthopedics, Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China
关键词:
股骨转子下骨折; 股骨重建钉; 环扎
Keywords:
Subtrochanteric fracture; Femoral reconstruction intramedullary nail; Cerclage
文献标志码:
B
摘要:
目的探讨侧卧位小切口钛缆环扎辅助复位联合股骨重建髓内钉治疗股骨转子下骨折的临床效果。 方法回顾性分析2015年3月~2018年2月19例Seinsheimer Ⅲ~V型股骨转子下骨折的临床资料，其中ⅢA型9例，ⅢB型6例，Ⅳ型2例，Ⅴ型2例，均为单侧闭合性骨折。侧卧位，小切口钛缆环扎辅助骨折复位，股骨重建髓内钉固定，术后常规抗凝治疗。 结果手术时间平均112.3 min（90~210 min），出血量214.3 ml（120~850 ml）。术后12周4例骨折愈合，术后20周均愈合。术后均随访12个月，髋关节功能Harris评分优11例，良6例，可2例，优良率89.5%（17/19）。无下肢深静脉血栓形成、髋内翻畸形、再次骨折、拉力螺钉切割股骨头及断钉等并发症。 结论侧卧位行股骨髓内钉固定治疗股骨转子下骨折，利用小切口钛缆环扎辅助骨折复位有利于维持蝶形骨块的复位及髓内钉的准确置入，不影响骨折愈合，是治疗Seinsheimer Ⅲ~Ⅴ型股骨转子下骨折的可靠的微创内固定方法。
Abstract:
ObjectiveTo investigate the clinical efficacy and surgical techniques of cable cerclage through a miniincision approach to assist reduction combined with long femoral reconstruction intramedullary nails for treatment of Seinsheimer type Ⅲ-Ⅴ subtrochanteric fractures in the lateral decubitus position.MethodsFrom March 2015 to February 2018, clinical data of 19 cases of Seinsheimer type Ⅲ-Ⅴ femoral subtrochanteric fractures were analyzed retrospectively, including 9 cases of ⅢA, 6 cases of ⅢB, 2 cases of Ⅳ and 2 cases of Ⅴ, all of which were unilateral closed fractures. All the operations were performed in the lateral decubitus position, with cable cerclage assisted reduction and intramedullary nail fixation. All the patients received routine anticoagulant therapy after operation.ResultsThe operative time was 90-210 min (mean, 112.3 min); the bleeding volume was 120-850 ml (mean, 214.3 ml). Four cases healed at 12 weeks after operation, and all healed at 20 weeks after operation. The patients were followed up for 12 months. The Harris scores of hip joint function at the last followup were excellent in 11 cases, good in 6 cases, and fair in 2 cases, yielding an excellent to good rate of 89.5% (17/19). No deep venous thrombosis of lower limb, hip varus deformity, refracture, or cutout of the femoral head by lag screw or broken screw was observed.ConclusionsLateral decubitus position femoral intramedullary nail fixation in the treatment of subtrochanteric fracture of femur, with the use of small incision titanium cable cerclage to assist fracture reduction, is conducive to maintaining the butterfly shaped bone block reduction and the accurate placement of intramedullary nail. It does not affect the fracture healing, being a reliable minimally invasive internal fixation method for Seinsheimer type Ⅲ-Ⅴ femoral subtrochanteric fractures.

参考文献/References:

[1]钱建军,李锦锦,江显俊.微创环扎辅助髓内钉治疗长斜形股骨转子下骨折的疗效分析.中国微创外科杂志,2019,19(12):1092-1095.
[2]熊文,陈明,郑琼.加长Gamma 3钉结合钛缆固定治疗Seinsheimer Ⅲ型老年股骨转子下骨折.中华创伤骨科杂志,2018,20(1):33-37.
[3]Panteli M，Mauffrey C，Giannoudis PV.Subtrochanteric fractures:issues and challenges.Injury,2017，48(10)：2023-2026.
[4]Kim KK,Won Y,Smith DH,et al.Clinical results of complex subtrochanteric femoral fractures with long cephalomedullary hip nail.Hip Pelvis,2017,29(2):113-119.
[5]Hoskins W,Bingham R,Joseph S,et al.Subtrochanteric fracture:the effect of cerclage wire on fracture reduction and outcome.Injury,2015,46(10):1992-1995.
[6]Wang J,Ma JX,Lu B,et al.Comparative finite element analysis of three implants fixing stable and unstable subtrochanteric femoral fractures:Proximal Femoral Nail Antirotation (PFNA),Proximal Femoral Locking Plate (PFLP),and Reverse Less Invasive Stabilization System (LISS).Orthop Traumatol Surg Res,2020,106(1):95-101.
[7]王连净,曾宪铁.防旋股骨近端髓内钉Ⅱ和亚洲股骨髓内钉内固定修复老年股骨转子下骨折的生物力学分析.中国组织工程研究,2016,20(31):4644-4650.
[8]Wang PC,Ren D,Song CH,et al.Surgical technique for subtrochanteric fracture of femur.Orthop Surg,2016,8(4):516-518.
[9]刘兆杰,胡永成.微创钢缆辅助加长头颈型髓内钉治疗股骨转子下骨折.中华骨科杂志,2017,37(22):1392-1399.
[10]Afsari A,Liporace F,Lindvall E,et al.Clampassisted reduction of high subtrochanteric fractures of the femur.J Bone Joint Surg Am,2009,91(8):1913-1918.
[11]Trikha V,Das S,Agrawal P,et al.Role of percutaneous cerclage wire in the management of subtrochanteric fractures treated with intramedullary nails.Chin J Traumatol,2018,21(1):42-49.
[12]张启栋，郭万首,岳德波,等.初次全髋关节置换术中Corail柄假体周围骨折原因与防治.中华创伤杂志,2017,33(1)：69-74.
[13]Codesido P,Mejía A,Riego J,et al.Cerclage wiring through a miniopen approach to assist reduction of subtrochanteric fractures treated with cephalomedullary fixation:surgical technique.J Orthop Trauma,2017,31(8):e263-e268.
[14]Apivatthakakul T,Phaliphot J,Leuvitoonvechkit S.Percutaneous cerclage wiring,does it disrupt femoral blood supply?A cadaveric injection study.Injury,2013,44(2):168-174.
[15]Perren SM,Fernandez Dell’Oca A,Lenz M,et al.Cerclage,evolution and potential of a Cinderella technology.An overview with reference to periprosthetic fractures.Acta Chir Orthop Traumatol Cech,2011,78(3):190-199.

备注/Memo

备注/Memo:
*通讯作者，Email：609409432@qq.com
更新日期/Last Update: 2021-08-06