股骨转子间骨折外侧壁的临床意义及其损伤的内固定治疗

doi:10.3969/j.issn.2095-4344.2821

中国组织工程研究 ›› 2020, Vol. 24 ›› Issue (30): 4854-4859.doi: 10.3969/j.issn.2095-4344.2821

• 骨与关节综述 bone and joint review • 上一篇下一篇

股骨转子间骨折外侧壁的临床意义及其损伤的内固定治疗

陶金1，熊贵润1，刘蓬然2，焦瑞1，李小磊3，颜连启3

1扬州大学医学院，江苏省扬州市 225001；2中南大学湘雅二医院，湖南省长沙市 410000；3江苏省苏北人民医院骨科，江苏省扬州市 225001

收稿日期:2019-12-19 修回日期:2019-12-24 接受日期:2020-03-07 出版日期:2020-10-28 发布日期:2020-09-22
通讯作者: 颜连启，硕士，主任医师，江苏省苏北人民医院骨科，江苏省扬州市 225001
作者简介:陶金，男，1993年生，安徽省铜陵市人，汉族，扬州大学医学院在读硕士，主要从事骨软骨损伤与修复方面的研究。

Clinical significance of external wall of femoral intertrochanteric fracture and the treatment of internal fixation

Tao Jin1, Xiong Guirun1, Liu Pengran2, Jiao Rui1, Li Xiaolei3, Yan Lianqi3

1Medical College of Yangzhou University, Yangzhou 225001, Jiangsu Province, China; 2Second Xiangya Hospital of Central South University, Changsha 410000, Hunan Province, China; 3Department of Orthopedics, Subei People’s Hospital, Yangzhou 225001, Jiangsu Province, China

Received:2019-12-19 Revised:2019-12-24 Accepted:2020-03-07 Online:2020-10-28 Published:2020-09-22
Contact: Yan Lianqi, Master, Chief physician, Department of Orthopedics, Subei People’s Hospital, Yangzhou 225001, Jiangsu Province, China
About author:Tao Jin, Master candidate, Medical College of Yangzhou University, Yangzhou 225001, Jiangsu Province, China

摘要/Abstract

摘要：

文题释义：

股骨转子间骨折：指股骨颈基底部到股骨小转子之间的骨折，又称转子间骨折，是老年人常见的骨折之一。以局部疼痛、肿胀明显、瘀斑广泛，患肢明显短缩，内收和外旋畸形，具有低能量损伤特点。

外侧壁：作为最近几年的研究热点问题，越来越多的临床医师认识到外侧壁在股骨转子间骨折内固定术后发挥的重要作用，甚至是决定手术是否成功的关键因素。完整的外侧壁可以阻止头颈骨折块的外移、股骨头切割、髋关节内翻畸形等术后并发症，直接影响患者的预后状况。

背景：外侧壁概念作为近几年兴起的热点领域，对治疗股骨转子间骨折有很大的指导意义。

目的：综述外侧壁的定义、范围、厚度及其在股骨转子间骨折手术治疗过程中发挥的重要作用。

方法：检索万方、CNKI、PubMed、Web of Science等数据库，检索词为“股骨转子间骨折，外侧壁，骨折固定术”和“intertrochanteric fracture，fracture fixation，lateral wall”。将检索到的文献进行整理并分析总结。

结果与结论：①梳理了外侧壁的定义、范围、厚度的测量方法及其临床意义；②总结了基于外侧壁股骨转子间骨折的分类标准；③治疗上，列举了髓外固定、髓内固定、人工关节置换和其他治疗方式共4种治疗方式，并分析了术中术后外侧壁骨折的原因和治疗方法；④结果表明，外侧壁的完整性直接影响内固定的稳定性，甚至影响内固定的成功，完整的外侧壁可以阻止股骨远端内移及头钉退出，预防髋关节内翻畸形。临床医师应该借助详细的影像学检查，分析骨折类型，综合考虑各项因素，选择合适的修复方式。

ORCID: 0000-0001-8407-5277(陶金)

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 骨, 骨折, 股骨, 外侧壁, 关节, 固定, 髓外固定, 髓内固定, 关节置换

Abstract:

BACKGROUND: The concept of the lateral wall as a hot area has emerged in recent years, and has great guiding significance for the treatment of intertrochanteric fractures.

OBJECTIVE: To review the definition, scope, thickness of the lateral wall and its important role in the surgical treatment of intertrochanteric fractures.

METHODS: The authors searched Wanfang, CNKI, PubMed, and Web of Science. The search terms were

“intertrochanteric fracture, lateral wall, fracture fixation” in Chinese and English. The retrieved documents were sorted, analyzed and summarized.

RESULTS AND CONCLUSION: (1) The definition, scope, thickness and measurement method of the lateral wall and its clinical significance were sorted out. (2) Classification criteria based on lateral intertrochanteric fractures of the femur were summarized. (3) In terms of treatment, four kinds of treatment methods: extramedullary fixation, intramedullary fixation, artificial joint replacement and other treatment methods were listed. Causes and treatment of fracture of lateral wall during and after operation were analyzed. (4) The results showed that the integrity of the lateral wall directly affected the stability of the internal fixation, even the success of the internal fixation. The complete lateral wall can prevent the distal femur from moving inward and the head pin from withdrawing, and prevent the coxa varus deformity. Clinicians should make use of detailed imaging examination, analyze fracture types, comprehensively consider various factors, and select appropriate repair methods.

Key words: bone, fracture, femur, lateral wall, joint, fixation, extramedullary fixation, intramedullary fixation, artificial joint replacement

中图分类号:

陶金, 熊贵润, 刘蓬然, 焦瑞, 李小磊, 颜连启. 股骨转子间骨折外侧壁的临床意义及其损伤的内固定治疗[J]. 中国组织工程研究, 2020, 24(30): 4854-4859.

Tao Jin, Xiong Guirun, Liu Pengran, Jiao Rui, Li Xiaolei, Yan Lianqi. Clinical significance of external wall of femoral intertrochanteric fracture and the treatment of internal fixation[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(30): 4854-4859.

图/表（结果） 2

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股骨转子间骨折外侧壁的临床意义及其损伤的内固定治疗

Clinical significance of external wall of femoral intertrochanteric fracture and the treatment of internal fixation

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