股骨骨折闭合复位髓内固定后骨折端旋转移位CT测量.doc

股骨骨折闭合复位髓内固定后骨折端旋转移位CT测量 　 作者：姚琦　唐佩福　黄鹏　王继芳 【摘要】 　　［目的］通过CT测量股骨骨折髓内钉固定术后骨折端旋转移位程度，探讨术中纠正旋转畸形的方法。［方法］CT扫描测量56例股骨骨折闭合复位髓内钉固定后的前倾角值，并与健侧对照，计算双侧前倾角的差值，借此判断骨折远端旋转畸形的程度。前倾角增大表明骨折远端内旋，反之代表骨折远端外旋。根据AO分类标准，股骨粗隆下A3型骨折9例，股骨干A型骨折12例，B型骨折15例，C型骨折7例，股骨髁上A型骨折13例。［结果］所有入选病例的伤侧前倾角均发生变化，股骨干骨折的前倾角变化最大，为－13.35°～47.21°。粗隆下骨折的前倾角变化最小，为-7.12°～36.35°，髁上骨折的前倾角变化居中，为-11.10°～39.22°。骨折远端内旋移位的程度和发生率均大于外旋移位。内旋移位占60.71％，外旋移位占39.29％。股骨干骨折远端内旋移位的变化最大，为1.37°～29.82°，平均12.34°。粗隆下骨折远端内旋移位的变化最小，为0.81°～23.21°，平均8.32°。髁上骨折居中，为1.72°～27.11°，平均8.38°。骨折远端外旋移位仍以股骨干骨折表现最明显，为1.11°～21.12°，平均9.33°。粗隆下骨折变化最小，为1.31°～16.23°，平均7.71°。股骨髁上骨折变化居中，为0.97°～17.96°，平均8.22°。分别对３个骨折部位的健侧和伤侧配对t检验，P＜0.001，差异显著。［结论］股骨骨折闭合复位髓内钉固定术后，骨折端旋转移位的发生率非常高，术中影像监测可有效控制旋转移位。 【关键词】 股骨骨折 交锁髓内钉术后 CT 旋转畸形 　　CT scan to measure fracture malrotation after interlocking intramedullary nailing of femoral fracture∥ 　　Abstract：［Objective］To measure the extent of malrotation of femur fractures with CT scan after fixation with interlocking intramedullary nailing , and to discuss the methods which can help to correct the malrotation of femur fracture during the operation. ［Method］With CT scan, the anteversion of femur fracture after the close reduction and fixation with interlocking intramedullary nailing in 56 cases was measured, and the difference of anteversion between the fracture side and the contralateral side was evaluated. The increase of anteversion represented internal rotation of the distal fragment, whereas the decrease of anteversion meaned external rotation. According to AO classification system, the type A of infratrochanteric fractures happened in 9 cases, type A of femoral shaft fractures happened in 12 cases, type B in 15 cases,type C in 7 cases,and 13 cases of femoral supercondyle fractures were type A. ［Result］The results of measurement showed that the femoral anteversion after fixation with interlocking intramedullary nailing was changed in all patients. The anteversion of the femoral shaft fracture ranged from 13.35°to 47.21°. The an