【摘要】 [目的]探索利用小转子投影术中纠正股骨干骨折旋转畸形的准确率及临床疗效分析。[方法]回顾性分析本院2013年7月～2015年1月收治的股骨干骨折患者89例,年龄17～64岁,平均(38.73±11.65)岁。均以髓内钉进行固定,术中通过小转子宽度与股骨头中点至小转子基底部的比值调整旋转畸形。术后行双下肢CT检查,分别测量患侧和健侧的股骨前倾角(FAV),并两侧比较。行正侧位X线片,观察其内固定位置与骨折愈合情况,记录并发症发生率。[结果]术后CT测量FAV患侧为2.44°～43.21°,平均(20.62±7.31)°,健侧为11.30°～37.24°,平均(19.12±5.62)°,差异无统计学意义(P>0.05)。所有患者随访12～38月,平均(16.72±7.14)月。其中,84例骨折愈合,平均骨折愈合时间为(7.31±3.44)月;5例患者发生肥厚性骨不连,均为粗隆下骨折,通过断端置入单皮质钢板,平均于第2次手术后(5.40±1.24)个月骨性愈合。末次随访患者Harris评分76～93分,平均(86.72±3.16)分。[结论]利用小转子投影术中纠正股骨干骨折旋转畸形具有一定的准确性,稳定快速且方便,可作为术中快速判断是否存在旋转畸形的选择之一。更多还原

【Abstract】 [Objective] To explore the accuracy and clinical results of using the X-ray projection of the lesser trochanter to reduce the rotational displacement of the femoral shaft fracture during intramedullary nailing. [Methods] A retrospective study was conducted on 89 patients who were surgically treated for femoral shaft fracture from July 2013 to January 2015 in our hospital. All the patients, aged 17～64 years with an average of(38.73±11.65) years, underwent intramedullary nailing for internal fixation of the fractures. During operation, the ratio of the width of the lesser trochanter and the transverse distance from the basis of the less trochanter to the center of the femoral head was used as a reference for reduction of rotational displacement of the femoral shaft. After operation, the femoral anteversion angle(FAV) measured by CT scans of both lower extremities were compare between the affected and contralateral sides. In addition, full length X-ray films were obtained to observe the position of the implant and fracture healing, and the complications were recorded. [Results] After operation, the FAV measured by CT images proved of 2.44°～43.21° with a mean of(20.62±7.31)° on the fractured side, whereas 11.30°～37.24° with an average of(19.12±5.62)° on the uninvolved side, without a statistically significant difference between the two sides(P>0.05). The followup period lasted for 12～38 months with a mean of(16.72±7.14) months. Of them, 84 patients achieved bony healing in(7.31±3.44) months on average, while the remaining 5 patients who all suffered from subtrochanteric fracture were proved hypertrophic nonunion, which healed in(5.40±1.24) months on average after revision surgery with adding an unicortical plate. At the latest follow up, the Harris score ranged from 76 to 93 with an average of(86.72±3.16). [Conclusion] Using the X-ray projection of the lesser trochanter to reduce the rotational displacement of the femoral shaft is an accurate, consistent and convenient technique, which can be used as one of the choices to quickly determine whether or not rotational deformity present intraoperatively.更多还原