本文選題：轉(zhuǎn)子下骨折 + 股骨頸骨折��； 參考：《中國修復(fù)重建外科雜志》2017年09期

【摘要】：目的探討應(yīng)用髓內(nèi)釘聯(lián)合選擇性鋼纜環(huán)扎固定同側(cè)股骨頸骨折合并轉(zhuǎn)子下骨折的療效。方法 2012年6月—2015年12月,通過閉合復(fù)位股骨頸骨折,應(yīng)用微創(chuàng)切口髓內(nèi)釘聯(lián)合選擇性鋼纜環(huán)扎固定同側(cè)股骨頸骨折合并轉(zhuǎn)子下骨折19例。男5例,女14例;年齡35~77歲,中位年齡52歲。致傷原因:交通事故傷17例,摔傷2例。股骨頸骨折根據(jù)Garden分型:Ⅱ型7例,Ⅲ型8例,Ⅳ型4例;股骨轉(zhuǎn)子下骨折根據(jù)Seinsheimer分型:Ⅱ型9例,Ⅲ型5例,Ⅳ型3例,Ⅴ型2例。受傷至手術(shù)時(shí)間2~7 d,平均3.7 d。結(jié)果手術(shù)時(shí)間58~125 min,平均82.4 min;術(shù)中出血量225~725 m L,平均289.5 m L。術(shù)后切口均Ⅰ期愈合,無感染等早期并發(fā)癥發(fā)生。19例均獲隨訪,隨訪時(shí)間12~18個(gè)月,平均13.9個(gè)月。術(shù)后1個(gè)月患者尖頂距為9~23 mm,平均15.2 mm�；颊吖钦劬�,愈合時(shí)間18~42周,平均27.4周;其中1例術(shù)后3個(gè)月出現(xiàn)輕度髖內(nèi)翻,股骨頸出現(xiàn)輕度移位,頸干角約122°,術(shù)后42周骨折愈合。5例患者主訴骨折處輕微疼痛,不影響正常生活,疼痛視覺模擬評(píng)分(VAS)為1~3分,平均1.8分;其余患者VAS評(píng)分均為0分。16例患者逐漸恢復(fù)至術(shù)前行走水平。隨訪期間無骨不連、股骨頭缺血性壞死、內(nèi)固定失敗、螺釘切出及鋼纜松動(dòng)等并發(fā)癥發(fā)生。末次隨訪時(shí)Harris髖關(guān)節(jié)功能評(píng)分(HHS)為72~92分,平均82.8分;15例患者(78.9%)髖關(guān)節(jié)功能良好。結(jié)論髓內(nèi)釘聯(lián)合選擇性鋼纜環(huán)扎固定同側(cè)股骨頸骨折合并轉(zhuǎn)子下骨折,能夠通過提供良好的穩(wěn)定性恢復(fù)髖關(guān)節(jié)功能。
[Abstract]:Objective to investigate the effect of intramedullary nail combined with selective cable ligation for the fixation of the intertrochanteric fracture of the femoral neck. Methods from June 2012 to December 2015, 19 cases of femoral neck fracture combined with selective intramedullary cable cerclage fixation combined with selective intramedullary cervical intramedullary nail were used to fix the fracture of the femoral neck with a closed reduction of the femoral neck fracture. 5 males and females were treated with a minimally invasive incision of intramedullary nailing and selective steel cable cerclage. 14 cases, age 35~77, middle age 52. The cause of injury: 17 cases of traffic accidents and 2 cases of WwM. Femoral neck fracture according to Garden classification: type II 7 cases, type III 8 cases, type IV 4 cases, femoral subtrochanteric fracture according to Seinsheimer classification: type II 9 cases, type III 5 cases, type IV 3 cases, and type 2 cases. The injury to operation time is D, mean 3.7 D. results 58 operation time 58 ~125 min, average 82.4 min; intraoperative bleeding volume 225~725 m L, average 289.5 m L. incision were all first stage healing, no infection and other early complications of.19 cases were all followed up, followed up for 12~18 months, average 13.9 months. 1 months after operation, the spires were 9~23 mm, average 15.2 fractures healed, healing time, an average of 27.4 weeks; 1 cases had mild hip varus at 3 months after operation, slight dislocation of the neck of femur, 122 degrees of neck dry angle, 42 weeks of fracture healing in.5 patients complained of slight pain in the fracture, and no influence on normal life. The visual analogue score of pain (VAS) was 1~3, average 1.8, and the other patients with VAS score were 0.16 patients gradually recovered to preoperative walking. There were no bone nonunion, avascular necrosis of the femoral head, failure of internal fixation, screw cutting and loosening of steel cable during the follow-up period. The Harris hip function score (HHS) was 72~92 score, average 82.8 points at the last follow-up, and 15 patients (78.9%) had good hip function. Fracture of the subtrochanteric fracture can restore the hip joint function by providing good stability.
【作者單位】： 同濟(jì)大學(xué)附屬上海市第十人民醫(yī)院骨科;
【基金】：上海市自然科學(xué)基金項(xiàng)目(14ZR1432600)~~
【分類號(hào)】：R687.3

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