【摘要】 目的探索在手术中准确判断骨折端旋转移位程度的方法。方法1999年11月至2003年12月行闭合复位带锁髓内针固定术的股骨干骨折患者110例,其中第1组62例,术中将伤侧足置于中立位固定骨折;第2组27例,将骨折固定在股骨前倾角为15度的位置上;第3组21例,术中根据健侧股骨前倾角调整伤侧股骨干骨折的旋转对位并固定骨折。术后第3天摄X光片并行CT检查测量双侧股骨前倾角,伤侧与健侧股骨前倾角的差值为骨折端旋转移位的程度。另取正常人11例行CT检查测量双侧股骨前倾角作为对照组。结果对照组前倾角最大值为26度,最小值为8度,其中左侧平均值为12.82度,右侧平均值为12.45度,两侧差值最大为7度。治疗组健侧股骨前倾角的均值为:14.67度,最大值为51度,最小值为24度。治疗组伤侧股骨前倾角的均值为14.27度,最大值为40度,最小值为23度。第1组及第2组中旋转移位<10度者占53和52%,而>20度者为19和11%。与对照组相比差异有统计学意义(P<0.05)。第3组中,所有病例的旋转移位均<10度。与对照组相比无统计学意义。结论股骨干骨折闭合复位带锁髓内针固定后近50%的骨折存在>10度的旋转移位。在手术中使用X线透视设备可以准确调整股骨干骨折的旋转对位。只有以健侧的股骨前倾角为标准来调整伤侧股骨的旋转对位才能达到骨折旋转复位标准。更多还原

【Abstract】 Objective To explore the approach to accurately judge the degree of rotational deformity in femur shaft fracture. Methods 110 patients with femur shaft fracture were divided into 3 groups: Group A ( n =62) with the distal end of the fractured femur at the traumatic side at neutral position so as to fix the fracture, Group B ( n =27), with both the distal and proximal ends of the fractured femur at the neutral position so as to fix the femur at an antiversion angle of 15° d, and Group C ( n =21), with the degree of antiversion angle to be controlled to that on the intact side. X ray examination and CT scanning were conducted 3 days after intramedullary nailing to measure the degree of the antiversion angle on both sides. The difference between the degrees of antiversion angle at the 2 sides was considered the rotational deformity of the femur shaft after the nailing. The antiversion angles of the femurs at both sides of 11 healthy persons were measured as controls. Results The biggest value of antiversion angle was 26°, the smallest value was 8°, the average value at the left side was 12.8°, and the average value at the right side was 12.45 , and the biggest difference between the 2 side was 7° in the control group. The average antiversion angle of the femur was 14.67°, the biggest value was 51°, and the smallest value was -24°at the traumatic side; and the average antiversion angle of the femur was 14.27°, the biggest value was 40°, and the smallest value was -23° at the intact side in the treatment groups. 53% and 52% of the patients in Groups A and B showed a rotational deformity <10°, and 9% and 11% of them showed a rotational deformity >20°, significantly different from those in the control group (all P <0.05). The rotational deformity was <10° in all patients of Group C, not significantly different from that of the control group ( P >0.05). Conclusion Clinically about half of the femur shaft fractures are fixed in the position of rotational deformity >10° after nailing. The rotational deformity of femur shaft fracture should be prevented by comparing the antiversion angle on the intact side so as to achieve more reliable adequate reduction.更多还原