北京大学学报(医学版) ›› 2017, Vol. 49 ›› Issue (2): 246-251. doi: 10.3969/j.issn.1671-167X.2017.02.012

• 论著 • 上一篇    下一篇

颈基底型股骨粗隆部骨折的诊断及治疗

张铁超,张志山△,周方△,田耘,姬洪全,郭琰,吕扬,杨钟玮,侯国进   

  1. (北京大学第三医院骨科, 北京100191)
  • 出版日期:2017-04-18 发布日期:2017-04-18
  • 通讯作者: 张志山,周方, E-mail:ltlxl@sina.com, Zhou.md@126.com

Diagnosis and treatment for the basicervical fractures of the trochanteric region

ZHANG Tie-chao, ZHANG Zhi-shan△, ZHOU Fang△, TIAN Yun, JI Hong-quan, GUO Yan, LV Yang, YANG Zhong-wei, HOU Guo-jin   

  1. (Department of Orthopaedic Surgery, Peking University Third Hospital, Beijing 100191, China)
  • Online:2017-04-18 Published:2017-04-18
  • Contact: ZHANG Zhi-shan, ZHOU Fang E-mail:ltlxl@sina.com, Zhou.md@126.com

摘要:

目的:评估颈基底型股骨粗隆部骨折的特点和发生率,探究其诊断及治疗方式。方法: 选择北京大学第三医院骨科2005年1月至2016年5月收治的832例粗隆部骨折病例,其中28例(3.37%)为颈基底型骨折患者,对其进行回顾性分析,分别采用空心钉、动力髋螺钉(dynamic hip screw,DHS)、髓内钉固定系统3种内固定方法治疗,记录手术时间、术中出血量、隐性失血量、围术期失血总量、术后住院日、骨折愈合时间、Harris评分等数据并进行比较。结果: 髓内钉组16例,手术时间为55(20,120) min,术后平均住院日3(2,7) d,术中出血量为50(5,100) mL,隐性失血量为533.37(376.19,987.15) mL,失血总量为627.35(406.19,1037.16) mL,骨折平均愈合时间及最终Harris评分分别为6(3,9) 个月 和90.25(74,100)分;DHS组8例,手术时间为87.5(65,115) min,术后住院日5.5(2,17) d,术中出血量为100(50,300) mL,隐性失血量为278.11(202.43,849.97) mL,失血总量为580.19(368.55,899.97) mL,骨折平均愈合时间及最终Harris评分分别为5.5(4,12)个月和85.5(84,87)分;空心钉组4例,手术时间为47.5(35,75) min,术后住院日5(2,12) d,术中出血量为20(2,70) mL,隐性失血量为150(100.00,412.01) mL,失血总量为195.00(120.00,414.01) mL,骨折平均愈合时间及最终Harris评分分别为4(4,6)个月和80(61,97)分。髓内钉组和空心钉组手术时间明显少于DHS组,但前两组间差异无统计学意义(P=0.367)。3组患者术后住院日差异无统计学意义(P=0.053)。DHS组术中出血量明显高于另两组,而髓内钉组和空心钉组术中出血量差异无统计学意义(P=0.100)。隐性失血量髓内钉组显著增多,另两组间差异无统计学意义(P=0.134)。围术期失血总量空心钉组与其他两组比较相对较少,髓内钉组与DHS组差异无统计学意义(P=0.483)。患者平均随访时间4.74年(1~10年),采用空心钉治疗的一名患者术后3个月出现内固定失败。3组患者平均骨折愈合时间及最终随访时Harris评分差异无统计学意义(P>0.05)。结论: 颈基底型骨折的发生率较低,无移位骨折患者可通过术前X线片确诊,对于骨折移位患者,建议完善术前CT+三维重建以确诊;闭合复位手术内固定治疗应作为首选治疗方式;采用DHS或髓内固定系统治疗效果较好。

关键词: 颈基底型骨折, 粗隆间骨折, 囊外骨折, 诊断, 治疗

Abstract:

Objective: To evaluate the rate of basicervical fractures and document their diagnosis and treatment. Methods: From January 2005 to May 2016, 28 basicervical fractures of the 832 trochanteric fractures were collected and evaluated. The patients were treated with multiple screws, dynamic hip screw (DHS), intramedullary nail. Via the operation time, postoperative hospitalization, loss of blood duration the operation, hidden blood loss, total blood loss, mean union time and the final follow-up Harris hip score, the characteristics of different internal fixations were compared and analyzed. Results: The incidence of basicervical fractures was 3.37% (28/832) in our study. In the intramedullary nail group (16 patients), the operation time was 55 (20,120) min, the postoperative hospitalization was 3(2, 7) d, the intraoperative blood loss was 50(5,100) mL, the hidden blood loss was 533.37 (376.19, 987.15) mL, and the total blood loss 627.35 (406.19, 1037.16) mL . The union time and final follow-up Harris score were 6 (3, 9) months and 90.25 (74,100) min. In the DHS group (8 patients), the operation time was 87.5 (65,115) min, the postoperative hospitalization was 5.5 (2, 17) d, the intraoperative blood loss was 100 (50,300) mL, the hidden blood loss was 278.11 (202.43, 849.97) mL, and the total blood loss 580.19 (368.55, 899.97) mL . The union time and final followup Harris score were 5.5 (4, 12) months and 85.5 (84, 87) min. In the multiple screws group (4 patients), the operation time was 47.5 (35, 75) min, the postoperative hospitalization was 5 (2, 12) d, the intraope-rative blood loss was 20 (2, 70) mL, the hidden blood loss was 150 (100.00, 412.01) mL, and the total blood loss 195.00 (120.00, 414.01) mL. The union time and final follow-up Harris score were 4 (4, 6) months and 80 (61, 97) min. The patients treated with multiple screws and intramedullary nail had a shorter operation time than the DNS group, but no obvious difference was found between the other two groups (P=0.367). Postoperative hospitalization had no significant difference among the three groups. The intraoperative bleeding was more in the DHS group, the other two groups had no significant difference (P=0.100). However, the hidden blood loss was more in the intramedullary nail group, the other two groups had no significant difference (P=0.134). The total blood loss in the intramedullary nail group was more than multiple screw group, similar to the DHS group (P=0.483). One patient treated with multiple screws underwent internal fixation failure three months after operation. The mean union time and final follow-up Harris scores had no significant difference among the three groups (P>0.05). Conclusion: Through this study, we found that the incidence of basicervical fractures is low. Fractures with no shift can be confirmed by preoperative X-ray. For displaced fractures, preoperative CT + 3D reconstruction is recommended. Surgical treatment by closed reduction and internal fixation with DHS or intramedullary nail is shown to be very effective.

Key words: Basicervical fracture, Intertrochanteric fracture, Extracapsular fractures, Diagnosis, Therapy

中图分类号: 

  • R684
[1] 李熠,尉华杰,邱立新. 种植体折裂的临床分型与临床治疗方案[J]. 北京大学学报(医学版), 2022, 54(1): 126-133.
[2] 李伟浩,李伟,张学民,李清乐,焦洋,张韬,蒋京军,张小明. 去分支杂交手术和传统手术治疗胸腹主动脉瘤的结果比较[J]. 北京大学学报(医学版), 2022, 54(1): 177-181.
[3] 孟广艳,张筠肖,张渝昕,刘燕鹰. IgG4相关性疾病中枢神经系统受累的临床特点分析[J]. 北京大学学报(医学版), 2021, 53(6): 1043-1048.
[4] 张学武. 痛风关节炎治疗中几个备受关注的问题[J]. 北京大学学报(医学版), 2021, 53(6): 1017-1019.
[5] 翟莉,邱楠,宋惠. 多中心网状组织细胞增生症1例[J]. 北京大学学报(医学版), 2021, 53(6): 1183-1187.
[6] 王飞,朱翔,贺蓓,朱红,沈宁. 自发缓解的滤泡性细支气管炎伴非特异性间质性肺炎1例报道并文献复习[J]. 北京大学学报(医学版), 2021, 53(6): 1196-1200.
[7] 朱正达,高岩,何汶秀,方鑫,刘洋,魏攀,闫志敏,华红. 红色诺卡氏菌细胞壁骨架治疗糜烂型口腔扁平苔藓的疗效及安全性[J]. 北京大学学报(医学版), 2021, 53(5): 964-969.
[8] 洪鹏,田晓军,赵小钰,杨飞龙,刘茁,陆敏,赵磊,马潞林. 肾移植术后双侧乳头状肾癌1例[J]. 北京大学学报(医学版), 2021, 53(4): 811-813.
[9] 邱敏,费月阳,邓绍晖,刘承,卢剑,何为,陆敏,田晓军,张树栋,马潞林. 后肾腺瘤的诊治经验及文献回顾[J]. 北京大学学报(医学版), 2021, 53(2): 417-419.
[10] 孟圆,张丽琪,赵雅宁,柳登高,张祖燕,高岩. 67例上颌根尖周囊肿的三维影像特点分析[J]. 北京大学学报(医学版), 2021, 53(2): 396-401.
[11] 王昱,邓雪蓉,季兰岚,张晓慧,耿研,张卓莉. 超声检测痛风患者肌腱受累的危险因素和诊断价值[J]. 北京大学学报(医学版), 2021, 53(1): 143-149.
[12] 高璐,谷岩. 中国人群腭中缝形态特点分期与Demirjian牙龄的相关性[J]. 北京大学学报(医学版), 2021, 53(1): 133-138.
[13] 袁源,郎宁,袁慧书. CT能谱曲线在脊柱转移瘤和感染性病变中的鉴别诊断价值[J]. 北京大学学报(医学版), 2021, 53(1): 183-187.
[14] 周培茹, 蒋析, 华红. 口腔黏膜病患者口腔种植的时机及注意事项[J]. 北京大学学报(医学版), 2021, 53(1): 5-8.
[15] 贾园,栗占国. 成人巨噬细胞活化综合征诊断困境和个体化治疗[J]. 北京大学学报(医学版), 2020, 52(6): 991-994.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 张三. 中文标题测试[J]. 北京大学学报(医学版), 2010, 42(1): 1 -10 .
[2] 赵磊, 王天龙 . 右心室舒张末期容量监测用于肝移植术中容量管理的临床研究[J]. 北京大学学报(医学版), 2009, 41(2): 188 -191 .
[3] 万有, , 韩济生, John E. Pintar. 孤啡肽基因敲除小鼠电针镇痛作用增强[J]. 北京大学学报(医学版), 2009, 41(3): 376 -379 .
[4] 张燕, 韩志慧, 钟延丰, 王盛兰, 李玲玲, 郑丹枫. 骨骼肌活组织检查病理诊断技术的改进及应用[J]. 北京大学学报(医学版), 2009, 41(4): 459 -462 .
[5] 赵奇, 薛世华, 刘志勇, 吴凌云. 同向施压测定自酸蚀与全酸蚀粘接系统粘接强度[J]. 北京大学学报(医学版), 2010, 42(1): 82 -84 .
[6] 林红, 王玉凤, 吴野平. 学校生活技能教育对小学三年级学生行为问题影响的对照研究[J]. 北京大学学报(医学版), 2007, 39(3): 319 -322 .
[7] 丰雷, 程嘉, 王玉凤. 注意缺陷多动障碍儿童的运动协调功能[J]. 北京大学学报(医学版), 2007, 39(3): 333 -336 .
[8] 李岳玲, 钱秋瑾, 王玉凤. 儿童注意缺陷多动障碍成人期预后及其预测因素[J]. 北京大学学报(医学版), 2007, 39(3): 337 -340 .
[9] . 书讯[J]. 北京大学学报(医学版), 2007, 39(3): 225 -328 .
[10] 牟向东, 王广发, 刁小莉, 阙呈立. 肺黏膜相关淋巴组织型边缘区B细胞淋巴瘤一例[J]. 北京大学学报(医学版), 2007, 39(4): 346 -350 .