Comprehensive evaluation of intramedullary fixation and extramedullary fixation in the treatment of unstable femoral intertrochanteric fractures

doi:10.3969/j.issn.2095-4344.2013.35.006

Abstract

Abstract:

BACKGROUND: Nowadays, the internal fixation materials for the clinical treatment of unstable femoral intertrochanteric fractures are broadly divided into two categories: intramedullary fixation system and extramedullary fixation system. However, the effects of the treatments usually lack of macro evaluation.
OBJECTIVE: To compare the effect of intramedullary fixation system and extramedullary internal fixation system in the treatment of unstable femoral intertrochanteric fractures.
METHODS: 217 patients with unstable femoral intertrochanteric fracture (Evans typing: Ⅲ type to Ⅴ type and R type) were treated by using intramedullary fixation system and extramedullary internal fixation system: 18 cases were treated with dynamic condylar screw, 67 cases were treated with dynamic hip screw, 43 cases were treated with reconstruction nail, 72 cases were treated with proximal femoral anti-rotation blade nail, and 17 cases were treated with new generation of antegrade interlocking intramedullary nail. The operative time, length of incision, blood loss, time in bed, fracture healing time, complications and Harris hip score were analyzed and compared.
RESULTS AND CONCLUSION: In the aspects of operative time, blood loss, time in bed, complications and Harris hip score, the intramedullary fixation system was superior to extramedullary internal fixation system. But there were significant differences in the aspects of length of incision and fracture healing time between two methods. The results showed that the treatment of unstable femoral intertrochanteric fractures by using intramedullary fixation system was better than the extramedullary internal fixation system, as the intramedullary fixation system could effectively shorten the operative time and reduce blood loss. This stable and reliable fixation enables patients to take early postoperative functional exercise, and could significantly shorten the time in bed and reduce the incidence of complications and it is conducive to postoperative hip function recovery. Therefore, intramedullary fixation system is an ideal method for the treatment of unstable femoral intertrochanteric fractures.

Key words: bone and joint implants, orthopedic implants, femoral intertrochanteric fractures, intramedullary fixation system, unstable fractures, effective evaluation

CLC Number:

R318

Li Yan, Wang Dong, Sun Hai-yu, Liu Liang, Li Shu-wei. Comprehensive evaluation of intramedullary fixation and extramedullary fixation in the treatment of unstable femoral intertrochanteric fractures[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(35): 6254-6260.

Figures/Tables 5

2.4 两组术后并发症发生情况髓外系统组中有12例出现并发症：5例出现下肢深静脉血栓，就诊血管外科；3例出现严重的呼吸系统感染，就诊呼吸科；3例出现内固定失效，其中1例为内固定断裂，就诊骨科接受翻修手术，2例髋内翻，就诊骨科行截骨矫形手术；1例出现股骨头坏死，就诊骨科接受人工股骨头置换。髓内系统组中有7例出现并发症：3例出现下肢深静脉血栓，就诊血管外科；4例出现严重的呼吸系统感染，就诊呼吸科。 2.5 典型病例分析典型病例1：患者男性，47岁，因摔伤致左髋部肿痛、畸形2 h入院，诊断为：左股骨转子间骨折。给予胫骨结节牵引，经术前常规准备，于伤后第6天在硬膜外麻醉下行切开复位动力髁螺钉内固定治疗，见图1。典型病例2：患者男性，61岁，因摔伤致右髋部肿痛、畸形6 h入院，诊断为：右股骨转子间骨折。给予胫骨结节牵引，经术前常规准备，于伤后第5日在硬膜外麻醉下行切开复位动力髋螺钉内固定治疗，见图2。典型病例3：患者男性，43岁，因摔伤致左髋部肿痛、畸形5 h入院，诊断为：左股骨转子间骨折。给予胫骨结节牵引，经术前常规准备，于伤后第4天在硬膜外麻醉下行闭合复位重建钉内固定治疗，见图3。典型病例4：患者男性，78岁，因摔伤致右髋部肿痛、畸形9 h入院，诊断为：右股骨转子间骨折。给予胫骨结节牵引，经术前常规准备，于伤后第6天在硬膜外麻醉下行闭合复位股骨近端防旋刀片髓内钉内固定治疗，见图4。典型病例5：患者男性，85岁，因摔伤致左髋部肿痛、畸形2 h入院，诊断为：左股骨转子间骨折。给予胫骨结节牵引，经术前常规准备，于伤后第5天在全身麻醉下行闭合复位新一代双钉加压交锁髓内钉内固定治疗，见图5。"

References

[1] 危杰.股骨转子间骨折[J].中华创伤骨科杂志,2004,6(5):554- 557.

[2] 梅浩,袁艾东,李文锐.股骨转子间骨折治疗的研究现状[J].中华创伤杂志,2012,28(5):419-421 .

[3] 杨惠林,王根林.股骨转子间骨折治疗方法的选择[J].中华创伤杂志,2012,28(5):385-387 .

[4] 胥少汀,葛宝丰,徐印坎.实用骨科学[M].3版.北京:人民军医出版社,2005:710-711.

[5] 邱贵兴,戴尅戎.骨科手术学(上册)[M]. 3版.北京:人民卫生出版社,2010:313.

[6] Maxwell MJ, Moran CG, Moppett IK.Development and validation of a preoperative scoring system to predict 30 day mortality in patients undergoing hip fracture surgery.Br J Anaesth. 2008;101(4):511-517.

[7] Norvell DC,王簕,杨云峰.闭合性髋部骨折或长骨骨折围手术期抗生素预防性应用的疗效分析[J].中华创伤骨科杂志, 2009, 11(11): 1072-1078.

[8] 孙可. 抗生素在骨科围手术期的预防性应用[J].中国矫形外科杂志,2009,17(19):1473-1475.

[9] 林金矿,李毅中,俞海明,等.利伐沙班预防老年人髋部骨折术后下肢深静脉血栓形成的研究[J].中华创伤骨科杂志,2011,13(9): 885-887.

[10] 中华医学会骨科学分会创伤骨科学组.中国骨科创伤患者围手术期静脉血栓栓塞症预防的专家共识[J].中华创伤骨科杂志, 2012,14(6):461-463.

[11] 焦竞,黄玉成,李涛,等.不同内固定方式结合康复训练治疗老年股骨粗隆间骨折患者的疗效观察[J].中华物理医学与康复杂志, 2012,34(4):300-302.

[12] 林石明,郑玉堂,陈联源,等.DCS治疗股骨粗隆间不稳定骨折36例[J].中国骨与关节损伤杂志,2005,20(11):778.

[13] 谢瑞卿,张云飞,牛滕峰,等. 动力髁螺钉治疗不稳定性股骨粗隆间骨折[J].中国骨与关节损伤杂志,2006,21(1):66-67.

[14] 张宏宇,魏春生.DHS与DCS治疗老年股骨粗隆间骨折体会[J].中国骨与关节损伤杂志,2008,23(10):868-869.

[15] 童松林,高益斌,陆文杰,等.微创动力髋螺钉与动力髋螺钉治疗高龄粉碎性股骨转子间骨折的疗效比较[J].中华创伤杂志,2010, 26(3):231-233.

[16] 兰玉平,殷光义,钟风林,等.股骨重建钉治疗股骨干合并同侧股骨转子周围骨折[J].中华创伤骨科杂志,2006,8(7):688-689.

[17] 张朝,滕云升,郭永明,等.股骨重建钉治疗股骨不稳定粗隆间骨折[J].中国骨与关节损伤杂志,2005,20(10):699-700.

[18] 陈雁西,梅炯,毕刚,等.PFNA治疗股骨转子间伴或不伴外侧壁骨折的疗效分析[J].中华骨科杂志,2012,32(7):614-620.

[19] 唐佩福,姚琦,黄鹏,等.股骨近端髓内钉-螺旋刀片治疗高龄骨质疏松性股骨转子间骨折[J].中华创伤骨科杂志,2007, 9(7): 622-624.

[20] 洪全明,王平,刘军,等.DHS与Intertan髓内钉治疗股骨粗隆间骨折疗效分析[J].中国矫形外科杂志,2012,20(4):311-313.

[21] 蒋恺,秦涛,麻文谦,等.PFNA-Ⅱ及InterTan系统治疗股骨粗隆间骨折疗效评价[J].实用骨科杂志,2012,18(2):123-126.

[22] Harris WH.Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation.J Bone Joint Surg Am. 1969;51(4):737-755.

[23] 梁吉华,史源欣,邵伟忠,等.股骨近端防旋髓内钉与动力髋螺钉治疗股骨转子间骨折的疗效比较[J].中华创伤骨科杂志,2011, 13(9): 888-890.

[24] 方大标,王秋根. 95° DCS治疗股骨粗隆间及粗隆下粉碎性不稳定骨折[J].中国骨与关节损伤杂志,2005,20(8):518-520.

[25] 顾军,王明海,唐坚,等.多功能股骨近端重建钉治疗老年人股骨粗隆间骨折[J].中国骨与关节损伤杂志,2008,23(8):638-640.

[26] 刘贵明,孙德毅.闭合复位股骨重建钉治疗老年股骨粗隆下骨折[J].长治医学院学报,2011,25(1):34-36.

[27] 陈洪强,戴颖,赵滨,等.股骨重建钉治疗股骨不稳定粗隆间骨折39例分析[J].局解手术学杂志,2010,19(6):523.

[28] 王瑞,孔晓川,柳伟,等.微创短重建钉内固定治疗老年股骨转子间骨折[J].临床骨科杂志,2010,13(1):69-70.

[29] 俞光荣,王树青,饶志涛,等.防旋股骨近端髓内钉治疗不稳定性转子间骨折33例[J].中华创伤杂志,2007,23(2):83-86.

[30] 高翔.股骨近端防旋髓内钉微创治疗老年股骨粗隆间骨折的疗效观察[J].中国矫形外科杂志,2012,20(16):1463-1466.

[31] 李慧武,孙月华,史定伟,等.股骨近端防旋髓内钉治疗老年股骨转子间骨折112例[J].中华创伤杂志, 2011,27(11):990-994.

[32] 李玉茂,赵勇,李平生,等.股骨近端防旋髓内针(PFNA)治疗老年骨质疏松性股骨粗隆周围骨折[J].生物骨科材料与临床研究, 2011,8(3):53-55.

[33] 曾展鹏,苏博源,黄学员,等.微创股骨近端防旋髓内钉治疗股骨转子间骨折[J].中华创伤骨科杂志,2008,10(4):309-312.

[34] 汤欣,刘谟震,于利,等. 新一代髓内钉InterTAN在股骨转子间骨折治疗中的应用[J].中华创伤骨科杂志,2010,12(9):814-818 .

[35] 张巍,罗从风,曾炳芳.髓内钉INTERTAN治疗股骨近端骨折的回顾性分析[J].实用骨科杂志,2010,16(10):731-734.

[36] 周利均,屠文华,李杭.双钉加压交锁髓内钉在高龄股骨粗隆间骨折中的应用[J].浙江创伤外科,2012,17(2):185-186.

[37] 张培训,党育,薛峰,等.股骨近端防旋髓内钉治疗股骨转子间骨折中显性和隐性失血量分析[J].中华创伤杂志,2011,27(9): 755-788.

[38] 冯刚,潘志军,叶有晨.股骨转子间骨折围手术期隐性失血的比较研究[J].中华骨科杂志,2012,32(7):648-653.