引用本文:唐庭宇,于 利,汤 欣,阴宝盛,李长洲.InterTAN内固定治疗股骨转子间骨折并发症分析[J].大连医科大学学报,2017,39(4):343-348.
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InterTAN内固定治疗股骨转子间骨折并发症分析
唐庭宇, 于 利, 汤 欣, 阴宝盛, 李长洲
大连医科大学附属第一医院 创伤骨科, 辽宁 大连 116011
摘要:
目的 分析InterTAN髓内钉治疗股骨转子间骨折并发症的疗效。方法 回顾性分析2008年12月至2015年8月在大连医科大学附属第一医院创伤骨科采用InterTAN髓内钉内固定术治疗股骨转子间骨折482例的临床资料。其中男196例,女286例;年龄平均(74.1±15.6)岁;左侧231例,右侧251例。受伤机制:车祸伤58例,滑倒摔伤424例。骨折按照AO分型:A1型242例,A2型193例,A3型47例。观察术中、术后并发症,术后X线测量TAD值及颈干角。结果 术中拉力螺钉扩髓发生导针磨损1例;加压螺钉皮质开口时钻头尖端劈裂1例;插入髓内钉主钉导致股骨转子外侧壁爆裂2例;因扩髓不足及进针点不正确导致主钉进入困难2例;导针进入髓腔过深,辅助切口取出1例;远端锁定螺钉未进入髓内钉锁定孔3例。住院期间并发症33例,其中肺部感染10例,肺栓塞2例,创伤性谵妄20例,下肢深静脉血栓1例,并发症导致死亡3例。术后X线测量TAD平均(18.5±5.0)mm。健侧下颈干角平均(128.5±7.0)°,患侧颈干角平均(127.1±6.3)°,两者相比差异有统计学意义(P<0.05)。术后206例获得随访,随访率42.7%,术后随访时间:3~80个月,平均(35.8±15.8)个月。Harris评分平均(73.1±11.5)分,其中优97例,良70例,一般25例,差14例,优良率81.1%。骨折断端骨缺损2例,股骨头螺钉切出3例,主钉入口处骨缺损1例,同侧股骨远端骨折3例,对侧股骨转子间骨折9例。术后1~3个月发生下肢深静脉血栓8例。1年内死亡11例。结论 InterTAN髓内针能有效治疗股骨转子间骨折。通过对合并内科疾病积极治疗,细致的术中操作,及术后良好的功能锻炼能有效避免术中、术后并发症的发生。
关键词:  股骨转子间  骨折  并发症  髓内钉
DOI:10.11724/jdmu.2017.04.07
分类号:R683.42
基金项目:
Complications of InterTAN nail in the treatment of femoral intertrochanteric fracture
TANG Tingyu, YU Li, TANG Xin, YIN Baosheng, LI Changzhou
Trauma Department of Orthopedics,the First Affiliated Hospital of Dalian Medical University,Dalian 116011,China
Abstract:
Objective To analyze the complications of InterTAN nail system in the treatment of femoral intertrochanteric fracture. Methods We retrospectively analyzed 482 patients of intertrochanteric fracture, who were treated with InterTAN intramedullary nail fixation in the trauma department of orthopedics at the First Affiliated Hospital of Dalian Medical University from December 2008 to August 2015. Among them, 196 were male and 286 were female with an average age of (74.1±15.6) years old. Fracture occurred at left in 231 cases and right in 251 cases. The causes of injury included traffic accident in 58 cases, slip and fall in 424 cases. Fractures were classified according to AO type, including A1 type 242 cases, A2 type 193 cases, and A3 type 47 cases. The intraoperative and postoperative complications were observed, the TAD value and the postoperative collodiaphyseal angle were measured by X-ray. Results During surgery, the lead screw were worn out in 1 case; compression screw cortex opening drill tip splitting in 1 case; burst of rotor lateral femoral wall due to insertion of intramedullary nail screw in 2 cases; main nail insertion difficulty due to lack of reaming and incorrect needle point in 2 cases; guide pin into the medullary cavity too deep, auxiliary incision in 1 case; distal locking screws did not enter the intramedullary nail locking holes in 3 cases. Complications during hospital stay occurred in 33 cases, including 10 cases of pulmonary infection, 2 cases of pulmonary embolism, 20 cases of traumatic delirium, and 1 cases of deep venous thrombosis in lower extremity. Complications caused death in 3 cases. TAD on average was (18.5±5.0) mm after operation. The average collodiaphyseal angle was (128.5±7.0)° in healthy side, and (127.1±6.3)° in affected side. There were no significant difference between both(P>0.05. Bone defect in 2 cases, femoral head screw cut out in 3 cases, bone defect at the entrance of the main nail in 1 cases, of same distal femoral fractures in 3 cases and lateral intertrochanteric fractures in 9 cases. 206 cases were followed up with a follow-up rate of 42.7%, and the follow-up time was 3~80 months with an average (35.8±15.8). The average score of Harris was (73.1+11.5) points, among which 97 were excellent, 70 were good, 25 were general, and 14 were poor; the excellent and good rate was 81.1%. There were 11 cases of thrombosis in 1-3 months after operation, including 3 cases of cerebral thrombosis, 8 cases of lower extremity deep vein thrombosis. 11 patients died in 1 year. Conclusions InterTAN intramedullary nail system design can be effective in the treatment of femoral intertrochanteric fractures. Active treatment of medical diseases, careful operation, and good functional exercise can effectively avoid the occurrence of postoperative complications.
Key words:  Intertrochanteric of femur  fractures  complications  intramedullary nail