基于CT三维成像的难复性股骨粗隆间骨折分型与治疗

doi:10.6040/j.issn.1671-7554.0.2025.0443

摘要/Abstract

摘要： 目的基于CT三维成像建立难复性股骨粗隆间骨折(irreducible intertrochanteric fractures of the femur, IIFF)的分型系统,并探讨其术前识别和术中复位的临床价值。方法回顾性分析2015年1月至2021年12月股骨粗隆间骨折患者678例,筛选出经标准闭合复位尝试≤3次后,术中透视判定复位质量仍为“差”(Baumgaertner/Kim标准)的IIFF 78例(IIFF组)。依据CT三维成像的骨折形态、移位方向及软组织附着特点,提出一个包含5种亚型的分型系统(Ⅰ型:小粗隆相关型;Ⅱ型:大粗隆相关型;Ⅲ型:逆粗隆间型;Ⅳ型:完全移位型;Ⅴ型:合并粗隆下骨折型),并制定针对性复位策略。经倾向评分匹配选取非IIFF患者78例(对照组),对比两组手术时间、术中出血量、复位满意率、Harris髋关节评分及并发症发生率的差异。结果 IIFF组占所有股骨粗隆间骨折患者的11.5%(78/678)。应用针对性复位策略后,IIFF组复位满意率为83.3%,与对照组(84.6%)差异无统计学意义(P>0.05)。IIFF组手术时间［(67.3±24.2)min］较对照组［(55.8±19.5)min］显著延长(P<0.001),术中出血量［(210.5±75.1)mL］较对照组［(165.3±65.8)mL］显著增加(P<0.001);末次随访时,两组Harris评分、骨折愈合时间、并发症发生率与对照组相比差异无统计学意义(P>0.05)。结论该分型系统可有效识别IIFF,据此采用的针对性复位策略,虽增加了手术时间和术中出血,但能获得与易复性骨折相当的满意复位效果和良好临床预后,具有临床指导价值。

关键词: 难复性股骨粗隆间骨折, CT三维成像, 分型, 复位策略, 内固定

Abstract: Objective To establish a classification system for irreducible intertrochanteric fractures of the femur(IIFF)based on CT three-dimensional imaging and validate its clinical value in preoperative identification and intraoperative reduction. Methods A retrospective analysis was conducted on 678 patients with intertrochanteric fractures admitted between January 2015 and December 2021. Seventy-eight IIFF cases were identified, defined as those achieving “poor” reduction quality(Baumgaertner/Kim criteria)after ≤3 attempts of standard closed reduction. A novel 5-type classification system(Type Ⅰ: lesser trochanter-related; Type Ⅱ: greater trochanter-related; Type Ⅲ: reverse intertrochanteric; Type Ⅳ: completely displaced; Type Ⅴ: combined with subtrochanteric fracture)was proposed based on preoperative CT 3D imaging characteristics, including fracture morphology, displacement direction, and soft tissue attachment. Corresponding reduction strategies were formulated. Seventy-eight matched controls were selected from 600 non-IIFF patients via 1∶1 propensity score matching(PSM)for factors including age, sex, and AO classification. Results The incidence of IIFF was 11.5%(78/678). After applying targeted reduction strategies, the acceptable reduction rate in the IIFF group was 83.3%(65/78), showing no significant difference compared to the control group(84.6%, 66/78; P>0.05). Operative time in the IIFF group ［(67.3±24.2)min］ was significantly longer than that in the control group ［(55.8±19.5)min］(P<0.001), and intraoperative blood loss ［(210.5±75.1)mL］ was significantly greater than in controls ［(165.3±65.8)mL］(P<0.001). No significant differences were observed in Harris hip scores, fracture healing time, or complication rates at the final follow-up(all P>0.05). Conclusion The CT 3D imaging-based classification system enables effective preoperative identification of IIFF. The corresponding targeted reduction strategies, although increasing operative time and blood loss, can achieve satisfactory reduction and clinical outcomes comparable to those of reducible fractures, demonstrating significant clinical guiding value.

Key words: Irreducible intertrochanteric femoral fracture, CT 3D imaging, Classification, Reduction strategy, Internal fixation

中图分类号:

R683.3

林锦秀,李晔,尹德超,王鲲鹏,谭宝利. 基于CT三维成像的难复性股骨粗隆间骨折分型与治疗[J]. 山东大学学报 (医学版), 2025, 63(12): 61-73.

LIN Jinxiu, LI Ye, YIN Dechao, WANG Kunpeng, TAN Baoli. Classification and treatment of irreducible intertrochanteric femoral fractures based on CT 3-D imaging[J]. Journal of Shandong University (Health Sciences), 2025, 63(12): 61-73.

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