【摘要】 目的探讨采用有限切开复位钛缆联合加长Inter TAN髓内钉内固定治疗Seinsheimer Ⅴ型股骨转子下骨折的临床疗效。方法回顾性分析本院从2017年1月至2020年1月收治和采用有限切开复位钛缆联合加长Inter TAN髓内钉内固定治疗Seinsheimer Ⅴ型股骨转子下骨折病例资料,共26例(27髋)。其中,男19例,女7例;年龄39～76岁,平均53.8岁;损伤原因:车祸伤15例,摔伤3例,坠落伤8例。除1例为双侧损伤外,其余均为单侧损伤,右侧损伤10髋,左侧17髋。骨折分型均属股骨转子下Seinsheimer Ⅴ型,手术行牵引床预先复位,维持后有限切开钛缆预环扎复位,再行加长Inter TAN髓内钉内固定,末次随访时根据髋关节Harris评分标准评定疗效。结果本组26例患者均获得随访,随访时间9～42个月,平均17.2个月,末次随访时骨折均愈合,愈合时间12～25周,平均16.9周。未见血管神经损伤、伤口感染、内固定松动断裂、髋内翻、再次骨折等并发症。根据患者髋关节的疼痛、功能、活动范围等情况采用Harris髋关节评分标准评估手术疗效:优18髋,良7髋,中2髋,优良率92.6%。结论采用有限切开复位钛缆联合加长Inter TAN髓内钉内固定治疗Seinsheimer Ⅴ型股骨转子下骨折,具有固定可靠、并发症少、失败率低等优点,值得临床推广应用。更多还原

【Abstract】 Objective To explore the clinical effect of mini-incision approach reduction titanium cable combined with lengthened Inter TAN intramedullary nail internal fixation in the treatment of Seinsheimer type Ⅴ subtrochanteric fractures.Methods A retrospective analysis of 26 cases(27 hips) of patients with Seinsheimer type Ⅴ subtrochanteric femoral fractures treated in our department from January 2017 to January 2020 in our department and using the mini-incision approach reduction titanium cable combined with lengthened Inter TAN intramedullary nail internal fixation. Among them,there were 19 males and 7 females; the age was 39-76 years, with an average of 53.8 years old; the cause of injury: 15 cases of car accident injuries, 3 cases of falls, and 8 cases of fall injuries. Except for one case with bilateral injuries,the rest were unilateral injuries, with 10 hips on the right side and 17 hips on the left side. Fractures were classified as subtrochanteric Seinsheimer V type. The operation was pre-repositioned by traction bed, after maintenance, mini-incision approach and pre-cerclage reduction with titanium cable, and then internal fixation with lengthened Inter TAN intramedullary nail. Hip joint score was used the Harris standard assesses hip joint function. Results All 26 patients in this group were followed up for 9 to 42 months, with an average of 17.2 months. At the last follow-up, the fractures were all healed,and the healing time was 12-25 weeks, with an average of 16.9 weeks. There were no complications such as vascular and nerve injury, wound infection, loosening and breaking of internal fixation, hip varus, and re-fracture. According to the patient’s hip joint pain, function, range of motion and other conditions, the Harris hip scoring standard was used to evaluate the surgical effect: excellent in 18 hips, good in 7 hips, and fair in 2 hips, the excellent and good rate was92.6%. Conclusion Mini-incision approach reduction of titanium cable combined with lengthened Inter TAN intramedullary nail internal fixation for the treatment of Seinsheimer V-type femoral subtrochanteric fractures has the advantages of reliable fixation, fewer complications, and low failure rate. It is worthy of clinical application.更多还原