摘要
目的 探讨股骨头旋转中心至大转子后内缘与股骨颈上缘弧线投影交点间距结合伤、健侧股骨内、外髁后缘重叠"镜像"技术矫正股骨干粉碎骨折闭合复位髓内钉内固定术中股骨旋转移位的可行性及其临床疗效.方法 回顾性收集2020年1月至2022年12月于柳州市工人医院创伤中心采用闭合复位顺行带锁髓内钉内固定治疗成人单侧股骨干多段粉碎骨折患者52例的病历资料,男37例、女15例,年龄(44.4±3.5)岁(范围19～68岁).术中应用"C"型臂X线机透视确认并保持膝关节标准侧位(股骨内、外髁后缘水平重叠)下,透视髋关节正位像,标记髋关节正位像上股骨头旋转中心(O点)与大转子后内缘与股骨颈上缘弧线投影交点(Y点),测量并记录OY间距.通过内旋或外旋主钉瞄准架(股骨骨折近端随之调整),使伤侧与健侧OY间距保持一致,即可矫正股骨干骨折的旋转移位.术后CT测量双侧股骨颈前倾角,比较双侧股骨颈前倾角的差异以验证旋转控制的精确性.临床疗效评估采用骨折愈合率、下肢功能量表(lower extremity functional scale,LEFS)评分、Harris评分、Lysholm膝关节评分、髋和膝关节活动度及并发症发生情况.结果 术后健侧股骨颈前倾角为14.45°±3.23°,伤侧为14.21°±3.28°,双侧股骨颈前倾角的差异无统计学意义(t=1.063,P=0.168).两侧股骨颈前倾角差值为0.79°±0.58°(范围0°～2.5°).3例差值＞2°,最大差值为2.5°;10例差值为1°～2°;39例差值≤1°,其中2例差值为0°.末次随访时伤侧下肢LEFS评分、Harris评分、Lysholm膝关节评分与健侧的差异均无统计学意义(P＞0.05).末次随访时伤侧髋关节屈曲活动度为117.0°±2.2°、后伸24.3°±3.2°、外展33.4°±3.1°、内收20.8°±2.7°、内旋19.4°±3.5°、外旋38.2°±1.5°,健侧髋关节屈曲活动度为 122.0°±2.4°、后伸 25.4°±2.8°、外展 35.6°±2.0°、内收 23.4°±1.6°、内旋 21.0°±2.2°、外旋38.4°±1.8°,差异均无统计学意义(P＞0.05);伤侧膝关节屈曲活动度为135.0°±2.8°、健侧138.4°±1.2°,差异无统计学意义(P＞0.05).骨折愈合时间为(10.6±2.3)个月(范围6～13个月).术后第3天1例患者发生脂肪栓塞综合征,经给予激素、呼吸功能支持等治疗2周后痊愈;余51例均未出现血管神经损伤、脂肪栓塞、感染、下肢深静脉血栓形成、关节功能障碍等并发症.结论 股骨头旋转中心至大转子后内缘垂直投影间距结合伤、健侧股骨内、外髁后缘重叠的"镜像"技术可精准地判断和矫正股骨骨折的旋转移位.
Abstract
Objective To investigate the feasibility and clinical efficacy of using the mirror technique,which involves overlapping the distance between the center of rotation of the femoral head and the posteromedial edge of the greater trochanter,combined with the injured side and the posterior edge of the contralateral femoral medial and lateral condyles,to correct rotational displacement of the femur during closed reduction and intramedullary nail fixation for multi-level comminuted femoral shaft frac-tures.Methods This study included 52 adult patients with unilateral comminuted femoral shaft fractures treated with closed re-duction and antegrade interlocking intramedullary nail fixation at the Trauma Center of Liuzhou Workers'Hospital from January 2020 to December 2022.The cohort consisted of 37 males and 15 females,with an average age of 44.4±3.5 years(range 19-68 years).During the operation,C-arm fluoroscopy was used to confirm the standard lateral position of the knee joint,identified by overlapping the posterior edges of the medial and lateral femoral condyles.With this position maintained,X-ray fluoroscopy was performed on the hip joint in the anteroposterior view to identify the rotation center of the femoral head(point O)and the intersec-tion point of the arc projection between the posteromedial edge of the greater trochanter and the upper edge of the femoral neck(point Y).The distance from point O to point Y(OY)was measured and recorded.The rotational deformity of the femoral shaft frac-ture was corrected by internally or externally rotating the main screw sight frame to match the OY distance between the injured and healthy sides.Postoperative CT was used to measure bilateral femoral neck anteversion(FNA),and the difference in FNA be-tween the two sides was compared to verify the accuracy of rotation control.Clinical efficacy was evaluated based on fracture heal-ing rate,lower extremity functional scale(LEFS)score,Harris score,Lysholm knee score,hip and knee joint range of motion,and complications.Results The postoperative FNA was 14.45°±3.23° on the healthy side and 14.21°±3.28° on the injured side.The mean FNA difference between the two sides was 0.79°±0.58°(range 0°-2.5°).In 3 cases,the difference exceeded 2°,with a maxi-mum difference of 2.5°.In 10 cases,the difference ranged from 1° to 2°,and in 39 cases,the difference was ≤1°,including 2 cas-es with no difference.There was no significant difference in postoperative FNA between the two sides(t=1.063,P=0.168).At the last follow-up,there were no significant differences in LEFS score,Harris score,or Lysholm score between the injured and healthy sides(P＞0.05).The range of motion(ROM)of the hip joint at the last follow-up was 117.0°±2.2° in flexion,24.3°±3.2° in exten-sion,33.4°±3.1° in abduction,20.8°±2.7° in adduction,19.4°±3.5° in internal rotation,and 38.2°±1.5° in external rotation.The ROM of the healthy side was 122.0°±2.4° in flexion,25.4°±2.8° in extension,35.6°±2.0° in abduction,23.4°±1.6° in adduction,21.0°±2.2° in internal rotation,and 38.4°±1.8° in external rotation,with no significant differences(P＞0.05).The knee flexion ROM was 135.0°±2.8° on the injured side and 138.4°±1.2° on the healthy side,with no significant difference(P＞0.05).The frac-ture healing time was 10.6±2.3 months(range 6-13 months).One patient developed fat embolism syndrome on the third postopera-tive day and recovered after 2 weeks of hormone therapy and respiratory support.No other complications,such as vascular or nerve injury,infection,deep vein thrombosis,or joint dysfunction,were observed in the remaining 51 patients.Conclusion The meth-od of using the vertical projection distance between the center of rotation of the femoral head and the posteromedial edge of the greater trochanter,combined with the overlap of the injured side and the posterior edge of the medial and lateral femoral condyles,is a new quantitative approach.This technique accurately determines and corrects the rotational displacement of femoral fractures,offering an effective and quick intraoperative correction method.
基金项目
广西壮族自治区卫生健康委科研课题(Z-B20241503)
广西柳州市科技计划项目(2022SB021)
广西自然科学基金项目(2023GXNSFAA026407)
维普
万方数据