摘要目的 探讨不稳定型股骨转子间外侧壁骨折的治疗策略. 方法 回顾性分析2012年7月至2014年6月收治的50例不稳定型股骨转子间外侧壁骨折患者资料,男37例,女13例;平均年龄为65.6岁(42～87岁).作者根据外侧壁骨折后形态分型:Ⅰ型为单纯外侧壁粉碎,Ⅱ型为外侧壁劈裂,Ⅲ型为外侧壁及股骨转子下粉碎骨折,内侧股骨距粉碎.本组Ⅰ型25例,Ⅱ型4例,Ⅲ型21例.根据3种分型术中采用不同手术固定:Ⅰ型骨折采用股骨近端防旋髓内钉(PFNA)内固定结合螺钉重建外侧壁;Ⅱ型骨折通过钢缆重建外侧壁后行PFNA内固定;Ⅲ型骨折外侧壁无法重建,先解剖复位冠状位和颈干角,再采用PFNA内固定. 结果 50例患者术后获平均17个月(5～ 24个月)随访.无一例患者术后发生切口感染,2例患者发生深静脉血栓形成.所有患者骨折均获愈合,无螺钉切割和髋内翻畸形等并发症发生.随骨折分型加重,患者的手术时间、术中出血量、术后负重时间及骨折愈合时间增加.1例Ⅰ型骨折患者于术后5个月死亡,其余49例患者术后1年按髋关节Harris评分标准评定疗效:优40例,良6例,可3例,优良率为93.9％. 结论 对于不稳定型股骨转子间外侧壁骨折,依据外侧壁骨折形态进行分型并采用不同治疗方案治疗,能取得良好疗效.

abstractsObjective To investigate the surgical strategies for management of unstable fractures of intertrochanteric lateral wall.Methods From July 2012 to June 2014,50 patients with unstable fractures of intertrochanteric lateral wall received osteosynthesis with proximal femoral nail anti-rotation.They were 37 men and 13 women,with an average age of 65.6 years (range,from 42 to 87 years).According to our morphology classification,25 patients belonged to type Ⅰ (comminuted fracture of lateral wall),4 to type Ⅱ (split fracture of lateral wall with loss of medial support),21 to type Ⅲ (comminuted fracture of lateral wall and subtrochanteric part with loss of medial support).The fractures were managed differently according to our classification.Type Ⅰ were treated by intramedullary fixation with compression screws to reconstruct the lateral wall,type Ⅱ by intramedullary fixation after reconstruction of the lateral wall lby cables,and type Ⅲ by intramedullary fixation after optimal reduction of the coronal plane and neck-shaft angle because the lateral wall could not be reconstructed.Results The 50 patients obtained an average follow-up of 17 months (range,from 5 to 24 months).No deep infection or wound dehiscence happened.Deep vein thrombosis occurred in 2 patients.No nonunion,cutout of the sliding screw,or coxa vara occurred.The operation time,blood loss,time of weight loading after operation and time of union increased with our increased classification.One patient died from a heart disease 5 months after operation.Functional outcome of the other 49 patient was assessed by Harris hip score one year after operation.Forty patients were excellent,6 good and 3 fair,giving an excellent to good rate of 93.9％.Conclusion Unstable fractures of intertrochanteric lateral wall should be treated using different surgical strategies based on the morphology classification system.