股骨近端解剖锁定钢板治疗伴外侧壁骨折的股骨转子间骨折中期疗效随访

目的 :对股骨近端解剖型钢板治疗伴外侧壁骨折的转子间骨折中期疗效进行回顾性研究。方法 :2010年6月至2013年1月采用股骨近端解剖型钢板固定治疗转子间伴外侧壁骨折18例,男8例,女10例;年龄19~83岁,平均75.5岁;车祸伤8例,摔伤6例,高处坠落伤4例;受伤至手术时间为1~14 d,平均4.5 d;随访时拍摄股骨正侧位X线片。记录患者手术时间、术中出血量、住院天数,术后疗效评价采用Parker Palmer mobility score(PPMS)及Harris髋关节功能评分标准。结果:18例患者均获得随访,时间36~68个月,平均(44.8±8.8)个月。手术时间(61.02±38.28)min,术中出血量(226.00±162.52)ml,住院时间(10.8±9.2)d。所有患者未出现局部感染、深静脉血栓、螺钉切割股骨头及断钉,2例患者出现不同程度髋内翻短缩畸形,无骨折不愈合患者。骨折愈合时间为4~10个月,平均6.2个月。末次随访时,PPMS评分为(7.22±2.36)分;Harris评分为(79.46±11.02)分,其中优5例,良9例,可2例。结论:解剖型锁定钢板治疗伴外侧壁骨折的转子间骨折中期疗效显著,术中可避免外侧壁二次损伤,尤其对外侧壁严重粉碎、髓内钉操作困难以及高龄骨质疏松者,术后需严格随访,不应强调过早负重。

A medium term therapeutic effects of anatomic locking plate for femoral intertrochanteric with lateral femoral wall fractures

Objective: To retrospectively study medium term follow-up outcomes of the femoral intertrochanteric with lateral femoral wall fractures using anatomic locking plate fixation.Methods: From June 2010 to January 2013,18 cases of the unstable femoral intertrochanteric with lateral femoral wall fractures were treated with the anatomic locking plate,included 8 males and 10 females with an average age of 75.5 years ranging from 19 to 83 years old. There were 8 cases of traffic accident injuries,6 cases of falls injuries,and 4 cases of falling from high place. The time from injury to operation was ranged from 1 to 14 days with an average of 4.5 days. The operation time,intraoperative blood loss and the length of hospitalization were recorded and analyzed. The fracture union was assessed by follow-up radiographs and hip functional recovery by PPMS and Harris hip scoring.Results: All patients were followed up from 36 to 68 months with a mean of(44.8±8.8)months. The mean operative time was(61.02±38.28)min;the mean blood loss was(226.00±162.52)ml;the mean length of hospitalization was(10.8±9.2)days. During the follow-up period,no infection,deep veintllrombosis,screwed cut-out and implant failure occurred in all patients. Coxa vara with shortening deformity was noted in 2 cases. Bone union was found in all the cases. The bone healing time was ranged from 4 to 10 months with an average of 6.2 months. The mean PPMS score at the final follow-up was 7.22±2.36. The Harris score was 79.46±11.02,5 cases were classified as excellent,9 as good and 2 as fair.Conclusion: Proximal femoral anatomic locking plate can be used in treating intertrochanteric fractures with compromised lateral wall,which has a satisfied medium term follow-up outcomes,especially for complex fractures patterns in which intramedullary nailing may be difficult,and should not emphasis on premature loading.