【作者】 王俭；

【导师】 叶招明；

【作者基本信息】 浙江大学 ， 外科学（骨外）， 2016， 硕士

【摘要】 目的探讨伴有后方冠状面骨折的A2.3型股骨转子间骨折的特点、手术技巧和疗效。方法选取2011年1月～2014年1月期间,采用股骨近端防旋髓内钉治疗33例伴有后方冠状面骨折的股骨转子间骨折的患者,其中男15例,女18例；年龄61～92岁,平均(73.1±8.2)岁；按照AO/OTA分型,均为A2.3型；均为闭合性骨折。均采取了有限切开辅助复位内固定术,采用Harris髋关节评分标准对术后疗效进行评价。结果1例术后19d死亡,32例获得了随访,随访时间为9-24个月,平均(16.3±5.1)个月；根据X线片随访,骨折愈合时间为6-9个月,平均(7.2±1.5)个月。末次随访时Harris髋关节功能评分为76～95分,平均(85.3～5.6)分；其中优13例,良16例,可3例,优良率为90.6%(29/32)结论伴有后方冠状面骨折的A2.3型股骨转子间骨折类型特殊,复位困难,又相当不稳定,需使用辅助切口复位,并采用近端抗旋髓内钉固定,术后康复锻炼亦需个体化。更多还原

【Abstract】 ObjectiveTo explore the characteristics,the operative techniques and effect of AO/OTA A2.3 Intertrochanteric fractures with coronal shear fractures in the rear.MethodsFrom January 2011 to January 2014,33 patients were treated with proximal femoral nail anti-rotation,who suffered AO/OTA A2.3 Intertrochanteric fractures with coronal shear fractures in the rear. The group included 15 males and 18 females.The range of their age was from 61 to 92 years old,with an average age of (73.1±8.2) years According to AO/OTA classification,all were type A2.3 fracture.All of the cases were closed fracture,treated with limited open reduction and internal fixation.The postoperative hip function was evaluated using Harris score.Results1 case was died at 19 days after operation.32 cases were followed up for (16.3±5.1) months (range,9-24months). Bone union was observed with the average time of(7.2±1.5)months(range,6-9months).At final follow up,Harris evaluation were 76-95 points, average (85.3±5.6)points.l3cases were classified as excellent,16 as good, and 3 as fair. The overall rate of excellent or good result was 90.6%(29/32).ConclusionAO/OTA A2.3 intertrochanteric fracture is irreducible variant and unstable with coronal shear fractures in the rear.It can be fixed with proximal femoral nail antirotation by limited open reduction. It is necessary that postoperative rehabilitation should be chosen individually.更多还原