动力髋螺钉与微创内固定系统钢板倒置治疗老年股骨转子间骨折的疗效比较

目的 比较动力髋螺钉(DHS)与股骨远端微创内固定系统(LISS)钢板倒置治疗老年股骨转子间骨折的疗效. 方法 回顾性分析2003年1月至2010年4月收治的128例65岁以上股骨转子间骨折患者资料,根据内固定方式不同分为两组:DHS组68例,男43例,女25例;平均年龄为(78.0±7.4)岁;采用DHS固定.LISS组60例,男41例,女19例;平均年龄为(79.1±7.8)岁;采用股骨远端LISS钢板倒置治疗.比较两组患者的手术时间、术中透视次数、术中出血量、骨折复位质量、骨折愈合时间、髋关节Harris评分及并发症发生率等. 结果 DHS组患者的手术时间较LISS组长,术中透视次数和术中出血量较LISS组多,差异均有统计学意义(P＜0.05).两组患者骨折解剖复位或接近解剖复位率、围手术期并发症发生率比较差异均无统计学意义(P＞0.05).DHS组52例患者获得随访,平均随访时间为(2.5±0.8)年;LISS组45例患者获得随访,平均随访时间为(2.2±0.6)年.末次随访时DHS组患者髋关节Harris评分[(82.7±10.8)分]较LISS组[(93.3±5.9)分]低,差异有统计学意义(P＜0.05),而两组患者的骨折愈合时间、术后并发症发生率比较差异均无统计学意义(P＞0.05). 结论 与DHS相比,股骨远端LISS钢板倒置内固定治疗老年股骨转子间骨折髋关节功能恢复更好,且手术时间更短、术中出血量和接受X线辐射量更少.     

钢板与髓内钉治疗股骨转子下骨折的疗效比较

目的比较钢板与股骨近端防旋髓内钉(PFNA)内固定治疗股骨转子下骨折的疗效。方法将52例股骨转子下骨折患者根据手术方法分为钢板组(采用倒置LISS钢板内固定,26例)和PFNA组(采用PFNA内固定,26例)。观察两组患者手术时间、出血量、术后住院时间、骨折愈合时间、术后并发症及髋关节功能。末次随访时采用Harris评分评价髋关节功能。结果患者均获得12个月随访。出血量钢板组大于PFNA组(P0. 05);术后骨折愈合时间PFNA组短于钢板组(P 0. 05);手术时间、术后住院时间、术后并发症发生率及术后12个月髋关节功能两组比较差异无统计学意义(P 0. 05)。结论对于股骨转子下骨折,采用倒置LISS钢板或PFNA内固定治疗均可获得满意髋关节功能,但PFNA手术创伤较小、骨折愈合时间短。     

微创内固定系统接骨板倒置治疗股骨转子部骨折的适应证探讨

目的 总结微创内固定系统(LISS)接骨板倒置治疗股骨转子部骨折的疗效,并探讨其适应证. 方法 回顾性分析2005年6月至2011年6月期间采用LISS接骨板倒置治疗的72例股骨转子部骨折患者资料,男33例,女39例;平均年龄为73.4岁(45 ～87岁).记录本组患者的手术时间、术中出血量、围手术期并发症及末次随访时内固定相关并发症的发生情况等.术后随访摄X线片评估骨折愈合情况,采用髋关节Harris评分标准评定患者术后关节功能. 结果 本组患者手术时间平均为141.4 min,术中出血量平均为138.1 mL.围手术期并发症:下肢深静脉血栓形成3例,肺炎1例,消化道出血1例,多脏器功能衰竭致患者死亡1例,术后谵妄1例.65例(90.3％)患者术后获平均22.1个月(18 ～46个月)随访.骨折愈合时间平均为4.2个月(3～8个月).末次随访时髋关节Harris评分平均为73.7分(20 ～100分),其中优8例,良19例,可25例,差13例,优良率为41.5％.末次随访时内固定相关并发症的发生率为15.4％ (10/65),包括螺钉断裂6例,骨折不愈合1例,钢板断裂1例,螺钉松动1例,骨折畸形愈合1例. 结论 LISS接骨板倒置治疗股骨转子部骨折的并发症发生率较高,不宜作为常规方法,其适应证为AO分型31A2.2型以上的复杂骨折、髓腔过小或前弓过大者、病理性骨折、假体周围骨折及多发伤需控制创伤者.     

DHS与PFN治疗老年不稳定型转子间骨折

目的比较老年不稳定型转子间骨折采用动力髋螺钉和股骨近端髓内钉固定的手术疗效。方法62例不稳定型老年转子间骨折患者中,30例采用动力髋螺钉固定,32例采用股骨近端髓内钉固定,并对手术资料、术后并发症及髋关节功能进行临床随访分析。结果与DHS组相比,PFN组手术时间短,切口小,术中出血量及术后引流量少,骨折临床愈合时间短,且可早期下床负重而不增加术后并发症发生率。结论PFN技术创伤小、操作简单、固定牢靠、并发症少,是治疗老年不稳定型转子间骨折的理想方法之一。     

微创固定系统倒置治疗股骨转子下骨折

[目的]探讨微创固定系统(less invasive stabilization system,LISS)倒置治疗股骨转子下骨折的治疗方法和临床疗效。[方法]2007年10月～2009年5月,采用倒置LISS治疗31例股骨转子下骨折。本组男23例,女8例;年龄27～83岁,平均48.6岁。致伤原因:交通伤12例,坠落伤6例,压砸伤4例,摔伤9例。骨折按Seinshei-mer分型,ⅡC型4例,ⅢA型12例,ⅢB型6例,Ⅳ型6例,Ⅴ型3例。手术方法:麻醉满意后利用牵引床对股骨转子下骨折进行闭合复位,此后通过大转子外侧切口将对侧的LISS钢板倒置插入,骨折复位满意、钢板位置适宜后,在瞄准臂引导下分别在远、近骨折段钻入4～5枚锁定螺钉。[结果]本组手术时间35～80min,平均50min;术中出血60～150ml,平均失血量90ml。31例患者随访平均15.6个月,术后平均18.2周X线片显示明显骨痂形成或骨折线消失。无内固定松动及深部感染。患肢髋关节平均活动度为:屈曲115°,外旋35°,内旋15°,内收15°,外展36°。采用改良Harris髋关节评分法进行评估,平均92.6分(82～100分),优24例,良7例,无疗效不良病例。[结论]倒置LISS微创固定股骨转子下骨折效果良好,具有固定可靠、手术创伤小等优点,是一种治疗股骨转子下骨折的有效方法。     

人工股骨头置换与髓内固定治疗脑卒中后老年股骨转子间骨折的疗效比较

目的 比较人工股骨头置换与髓内固定治疗脑卒中后老年股骨转子间骨折的疗效.方法 对2005年6月至2011年6月期间收治的32例脑卒中后老年股骨转子间骨折患者资料进行回顾性分析,男8例,女24例;年龄为65 ～91岁,平均80.3岁;骨折AO分型:AI型8例,A2型14例,A3型10例.根据治疗方式不同分为两组:股骨头置换组(采用人工股骨头置换治疗,12例)和髓内固定组(采用髓内钉固定治疗,20例).记录并比较两组患者的切口长度、术中出血量、手术时间、术后下地时间、围手术期及术后1年并发症发生情况、术后1年髋关节Harris评分. 结果 股骨头置换组和髓内固定组患者的切口长度平均分别为(10.0±2.1)、(5.1±2.3)cm,术中出血量平均分别为(301.8±98.2)、(156.3±45.1)mL,术后下地时间平均分别为(6.4±2.9)、(30.5±8.7)d,围手术期并发症发生率分别为33.3％ (4/12)、65.0％ (13/20),术后1年髋关节Harris评分总分平均分别为(61.3±5.4)、(57.4±4.6)分,差异均有统计学意义(P＜0.05).股骨头置换组和髓内固定组患者的手术时间平均分别为(54.1±12.5)、(65.2±15.7) min,术后1年并发症发生率分别为25.0％ (3/12)、26.3％(5/19),差异均无统计学意义(P＞0.05). 结论 人工股骨头置换治疗脑卒中后老年股骨转子间骨折在降低围手术期并发症发生率、提早术后下地时间和改善髋关节功能方面较髓内固定有优势.     

三种不同内固定方式治疗股骨转子间不稳定型骨折的疗效比较

目的 比较动力髋螺钉(DHS)、股骨近端防旋髓内钉(PFNA)及倒置股骨远端微创内固定系统(LISS-DF)治疗股骨转子间不稳定型骨折的临床疗效.方法 对2008年1月至2010年10月收治且获得随访的42例股骨转子间不稳定型骨折患者资料进行回顾性分析,男23例,女19例;平均年龄为66.3岁(19 ～96岁).根据内固定方式不同分为3组:DHS组20例,PFNA组16例,倒置LISS-DF组6例.3组患者术前一般资料比较差异均无统计学意义(P＞0 05),具有可比性.比较3维患者的手术时间、术中出血量、骨折复位质量、住院时间、术后负重时间、骨折愈合时间、术后并发症发生情况及术后6个月髋关节Harris评分等. 结果 42例患者术后获6～30个月(平均18.5个月)随访.DHS组、PFNA组、倒置LISS-DF组术中出血量平均分别为(364.5±262.2)、(176.3±86.3)、(205.0±77.1)mL,术后负重时间平均分别为(25.9±6.3)、(16.7±3.5)、(23.8±4.0)d,以上项目3组间两两比较差异均有统计学意义(P＜0.05).3组患者在手术时间、骨折复位质量、住院时间、骨折禽合时间、术后6个月髋关节Harris评分及术后并发症等方面比较差异均无统计学意义(P＞0.05).结论 PFNA是股骨转子间不稳定型骨折较适合的内固定物,当应用PFNA出现困难时,可考虑选择DHS及倒置LISS-DF进行内固定.     

3种内固定手术治疗胫骨干骨折的疗效分析

目的比较LISS钢板、解剖钢板与交锁髓内钉内固定治疗胫骨干骨折的临床疗效。方法回顾性分析自2009-07—2013-06诊治的68例胫骨干骨折,采用LISS钢板内固定24例(LISS组),采用解剖钢板内固定20例(解剖钢板组),采用交锁髓内钉内固定24例(髓内钉组)。结果 68例均获得随访,随访时间12~24(17.33±3.17)个月。LISS组与髓内钉组在手术时间、术中出血量、开始负重时间、骨折愈合时间、膝关节外科临床评分优良率、并发症发生率方面优于解剖钢板组,差异有统计学意义(P0.05);而LISS组与髓内钉组比较差异无统计学意义(P0.05)。结论 LISS钢板和髓内钉内固定治疗胫骨干骨折对周围软组织损伤少,患者术后恢复快,术后感染和骨折不愈合的发生率均较低。     

微创内固定系统和防旋股骨近端髓内钉内固定治疗老年股骨近端骨折效果比较

目的比较微创内固定系统(LISS)和防旋股骨近端髓内钉(PFNA)内固定治疗老年股骨近端骨折效果。方法选取2017-01—2019-01间镇平县人民医院收治的106例老年股骨近端骨折患者,根据不同术式分为2组,各53例。LISS组采用LISS内固定,PFNA组采用PFNA内固定。回顾性分析患者的临床资料。结果 2组术中出血量、手术时间、住院时间、髋关节功能优良率、并发症发生率差异均无统计学意义(P0.05)。PFNA组骨折愈合时间、完全负重时间较对照组短,但术后10个月的颈干角小于LISS组,差异均有统计学意义(P0.05)。结论 PFNA、LISS内固定治疗老年股骨近端骨折,均可有效改善髋关节功能,安全性高。但PFNA内固定可缩短骨折愈合和完全负重时间;而对于内固定切割风险高、骨质疏松严重的患者,LISS内固定可减少术后髋内翻发生的概率。     

偏心固定与髓内固定治疗股骨转子间骨折的病例对照研究

目的 :比较股骨转子间骨折采用偏心固定及髓内固定两种方法的疗效,为股骨转子间骨折治疗方法的选择提供理论依据。方法:2007年2月至2010年1月收治股骨转子间骨折患者82例,其中偏心固定组39例,男16例,女23例,年龄41~81岁,平均(62.68±10.69)岁,采用动力髋或股骨近端锁定钢板固定;髓内固定组43例,男15例,女28例,年龄43~78岁,平均(62.60±8.37)岁,采用PFN或PFNA固定。比较两组患者的切口长度、手术时间、术中出血量以及术后Harris评分情况。结果:两组伤口均Ⅰ期愈合,无手术并发症。82例患者均获得随访,时间12~28个月,平均18.3个月。两组切口长度、手术时间、术中出血量差异具有统计学意义。两组术后1个月Harris髋关节功能评分比较差异有统计学意义(P<0.05),而术后12个月Harris髋关节功能评分差异无统计学意义(P>0.05)。偏心固定组优良率为89.7%,髓内固定组优良率为90.7%,差异无统计学意义(P>0.05)。偏心固定组骨折不愈合1例,动力髋主钉螺丝松动并继而发生髋内翻畸形。髓内固定组无防旋钉退出,髓内钉远端股骨再骨折1例。结论:两种方法治疗股骨转子间骨折均有良好疗效,但是髓内固定较偏心固定手术时间更短,出血量更少,适用于骨质疏松和不稳定型股骨转子间骨折的治疗。     

基于股骨近端外侧壁完整性的股骨近端骨折分型方法:附888例病例分析

背景:目前股骨转子部骨折的分型系统均存在一定局限性,反转子间骨折和转子下骨折存在分型交叉,而且目前的分型系统均未将转子部外侧壁包含在内。目的:提出股骨转子部骨折的区域分型法,分析新分型系统中各型临床特点。方法:根据股骨转子部外侧壁是否完整以及后内侧是否存在蝶形骨折块建立区域分型法。回顾性分析2005年4月至2016年12月收治的行内固定治疗的股骨转子部骨折患者共888例,分析区域分型系统中各分型患者基础资料以及骨折愈合时间、最终随访时Harris评分等。结果:Ⅰ~Ⅳ型骨折分别占79.8%(709例)、12.7%(113例)、3.2%(28例)和4.3%(38例)。各型患者间年龄、性别、受伤原因、复位方法、手术时间和术中出血量差异均有统计学意义(P均<0.01)。ⅠA型骨折髓内固定与动力髋螺钉(DHS)相比,最终随访时Harris评分、内固定物相关并发症发生率差异均无统计学意义。ⅠB型骨折髓内固定与微创内固定系统(R-LISS)相比,内固定相关并发症发生率差异有统计学意义(P<0.05)。Ⅱ型骨折采用转子间顺行髓内钉(InterTan)和股骨近端锁定接骨板(PFP)固定的患者,最终随访时Harris评分优良率分别为81.8%、62.5%,高于其他内固定物。Ⅲ型骨折髓内固定与R-LISS固定最终随访时Harris评分优良率分别为58.8%、50.0%。Ⅳ型骨折髓内固定与R-LISS固定最终随访时Harris评分优良率分别为76.9%、45.5%。结论:区域分型法可以较好的反映各型转子部骨折的特点,并指导内固定物的选择和提示预后。对于ⅠA型骨折,推荐采用DHS或髓内固定治疗;ⅠB型骨折推荐使用髓内固定治疗;Ⅱ型骨折因外侧壁不完整,推荐使用PFP或者InterTan治疗;Ⅲ型及Ⅳ型骨折推荐使用髓内固定治疗。     

A biomechanical comparison of proximal femoral nails and locking proximal anatomic femoral plates in femoral fracture fixation: A study on synthetic bones

Background:The incidence of fractures in the trochanteric area has risen with the increasing numbers of elderly people with osteoporosis. Although dynamic hip screw fixation is the gold standard for the treatment of stable intertrochanteric femur fractures, treatment of unstable intertrochanteric femur fractures still remains controversial. Intramedullary devices such as Gamma nail or proximal femoral nail and proximal anatomic femur plates are in use for the treatment of intertrochanteric femur fractures. There are still many investigations to find the optimal implant to treat these fractures with minimum complications. For this reason, we aimed to perform a biomechanical comparison of the proximal femoral nail and the locking proximal anatomic femoral plate in the treatment of unstable intertrochanteric fractures.Result:Nail and plate models were locked distally at the same level. Axial steady load with a 5 mm/m velocity was applied through the mechanical axis of femur bone models. Axial loading in the proximal femoral intramedullary nail group was 1.78-fold greater compared to the plate group. All bones that had the plate applied were fractured in the portion containing the distal locking screw.Conclusion:The proximal femoral intramedullary nail provides more stability and allows for earlier weight bearing than the locking plate when used for the treatment of unstable intertrochanteric fractures of the femur. Clinicians should be cautious for early weight bearing with locking plate for unstable intertrochanteric femur fractures.     

The treatment of unstable,extracapsular hip fractures with the AO/ASIF proximal femoral nail (PFN)--our first 60 cases

The most widely used implant in unstable proximal femoral fractures is the dynamic hip screw (DHS). Intramedullary implants include the intramedullary hip screw (IHMS), gamma nail and proximal femoral nail (PFN). There have not yet been any randomised trials comparing the PFN and DHS. We report our experience of stabilising 60 consecutive proximal femoral fractures with the PFN. Fifty fractures were unstable trochanteric fractures, seven were subtrochanteric (32A), one segmental, and two were at the level of a DHS plate. The mean age was 79 years and there were 12 male and 48 female patients. Twenty-eight patients were graded as ASA 3 or 4. Two patients had multiple injuries, all fractures were closed and there were five pathological fractures. The patients were followed up for a minimum of 4 months. Within this period, there were 12 deaths due to cardiopulmonary complications. Of the remaining 48 patients, two were lost to follow-up and 39 had united by 4 months. The local complications were: four implant cut-outs, two high energy fractures below the implants and one implant failure at 7 months due to delayed union. We believe that the PFN is a good choice for stabilising subtrochanteric fractures. We also believe that the use of the PFN for unstable trochanteric fractures is very encouraging. A large, randomised controlled trial against the DHS would be helpful to clarify the relative risks and benefits.     

股骨近端骨折髓内钉术后感染性骨不连的手术治疗

目的:探讨改良Ⅰ期手术治疗股骨近端骨折髓内钉术后感染性骨不连的方法和疗效。方法 :2010年6月至2015年6月采用改良Ⅰ期清创修复的手术方法治疗股骨近端骨折髓内钉术后感染性骨不连患者10例,其中男9例,女1例;年龄35~77岁。单纯股骨转子间骨折3例,股骨转子间合并股骨近端骨折2例,股骨转子下骨折5例。在彻底清创的基础上以股骨近端LISS钢板重新固定骨折端,用吻合血管游离腓骨移植加混有抗生素人工骨的自体松质骨植骨修复大段骨缺损,术后及早开始不负重关节功能锻炼。结果:所有患者获得随访,时间9~30个月。10例患者骨折均顺利愈合,随访期间无内固定断裂失效及感染复发病例,完全负重时间12~28周。末次随访采用Sanders创伤后髋关节评分标准评估术后髋关节功能:优7例,良2例,差1例。结论:改良Ⅰ期分次清创游离腓骨移植加载抗生素人工骨混合自体骨植骨LISS钢板固定的方法治疗股骨近端骨折髓内钉术后感染性骨不连,骨折愈合率高,髋关节功能恢复满意。在彻底清创的基础上综合运用控制感染与改善骨折愈合条件的各项措施是手术取得成功的关键。     

The new proximal femoral nail antirotation-Asia: early results

The proximal femoral nail antirotation system was introduced by the Arbeitsgemeinschaft fur Osteosynthesfragen/Association for the Study of Internal Fixation (AO/ASIF) in 2003 and is suitable for treating unstable trochanteric fractures. However, proximal femoral nail antirotation was designed according to the geometric proportions of the White population, and it is known that important differences exist between Asians and Americans with regard to femoral geometry. Reports of serious postoperative complications also exist when used for the elderly Asian population. Therefore, geometrical mismatch between proximal femoral nail antirotation and the femora of Asians has led the AO/ASIF to design a new proximal femoral nail antirotation for Asia with adapted sizes and geometry. This article reports early clinical results of using proximal femoral nail antirotation for Asians in 84 consecutive patients to stabilize unstable trochanteric fractures (AO classification, 31.A2 and A3). Patients were followed up for an average 8 months (range, 4-11 months). Intraoperative and postoperative complications, surgical details, and outcome measurements were evaluated. Fractures were treated by closed reduction and intramedullary fixation. The proximal femoral nail antirotation Asia position was ideal in 80 cases (95%). No patients showed complication related to the mismatch between the nail and femora. The mean time to bone healing was 14 weeks. Functionally, 90% of the patients regained pretrauma mobility. According to the Harris hip scoring system, 63 patients (78%) had an excellent or good outcome. The new proximal femoral nail antirotation Asia yields better results in the treatment of unstable trochanteric fractures in elderly patients by closely matching Asian femoral anatomy and thereby reducing complications related to the implants.     

Outcome of intramedullary nail for fixation of osteoporotic femoral shaft fractures in the elderly above 60

IntroductionIntramedullary nailing is an acceptable treatment option for femoral shaft fracture in young patients but not extensively studied in the elderly with osteoporotic fractures. Plate fixation for osteoporotic femoral shaft fractures have a high rate of complications and delayed healing time, and the most acceptable treatment is intramedullary nailing. This study evaluated the healing time and incidence of complications in osteoporotic femoral shaft fractures after intramedullary nailing.Patients &MethodsThis was a retrospective study that included 16 patients above 60 years old with osteoporotic femoral shaft fractures operated between January 2015 and December 2018. Patients with metastatic fractures or with atypical fractures were excluded. Thirteen patients had low-energy injuries such as a simple fall from standing height or lower and twisting injuries. The remaining 3 patients sustained high-energy-mechanism of injury. No patient received bisphosphonate except 2 patients received oral bisphosphonate for a period of 6 and 8 months, respectively.ResultsSixteen patients (12 females and 4 males) with mean age 69.5 ± 3.7 presented with femoral shaft fracture were operated with intramedullary nail, 10 patients were fixed with trochanteric entry nails with proximal neck screws, and 6 patients were fixed with piriformis entry nails. In 9 patients, closed reduction of fracture was achieved while 7 patients required open reduction, of which 5 fracture required cerclage wire addition. The mean bone healing time was 5.35±1.2 months. Intraoperative extension of femoral fractures during intramedullary nail insertion was observed in two cases that required open reduction and addition of cerclage wires around the fracture. The overall incidence of complications was 18.7%.ConclusionsIntramedullary nailing for osteoporotic femoral shaft fracture is a good acceptable option in elderly patients with reasonable healing time with no major complications.     

High Irritation and Removal Rates After Plate or Nail Fixation in Patients With Displaced Midshaft Clavicle Fractures

Background

Studies comparing plate with intramedullary nail fixation of displaced midshaft clavicle fractures show faster recovery in the plate group and implant-related complications in both groups after short-term followup (6 or 12 months). Knowledge of disability, complications, and removal rates beyond the first postoperative year will help surgeons in making a decision regarding optimal implant choice. However, comparative studies with followup beyond the first year or two are scarce.

Questions/purposes

We asked: (1) Does plate fixation or intramedullary nail fixation for displaced midshaft clavicle fractures result in less disability? (2) Which type of fixation, plate or intramedullary, is more frequently associated with implant-related irritation and implant removal? (3) Is plate or intramedullary fixation associated with postoperative complications beyond the first postoperative year?

Methods

Between January 2011 and August 2012, patients with displaced midshaft clavicle fractures were enrolled and randomized to plate or intramedullary nail fixation. A total of 58 patients with plate and 62 patients with intramedullary nails initially were enrolled. Minimum followup was 30 months (mean, 39 months; range, 30–51 months). Two patients (3%) with plate fixation and two patients (3%) with intramedullary nails were lost to followup. The QuickDASH was obtained at final followup and compared between patients who had plate fixation and those who had intramedullary nail fixation. Postoperative complications measured include infection, implant-related irritation, implant failure, nonunion, and refracture after implant removal. Indications for implant removal included implant-related irritation, implant failure, nonunion, patient’s wish, or surgeon’s preference.

Results

Between patients with plate versus intramedullary nail fixation, there were no differences in QuickDASH scores (plate, 1.8 ± 3.6; intramedullary nail, 1.8 ± 7.2; mean difference, −0.7; 95% CI, −2.2 to 2.04; p = 0.95). The proportion of patients having implant-related irritation was not different (39 of 56 [70%] versus 41 of 62 [66%]; relative risk, 1.05; 95% CI, 0.82–1.35; p = 0.683). Intramedullary fixation was associated with a higher likelihood of implant removal (51 of 62 [82%] versus 28 of 56 [50%]; relative risk, 1.65; 95% CI, 1.24–2.19; p < 0.001). Among the removed implants more plates than intramedullary nails were removed after the 1-year followup (12 of 28 [43%] versus six of 51 [12%]; p = 0.002). There were no infections, implant breakage, nonunions, or refractures between the 1-year and final followup in either group.

Conclusions

After a mean followup of 39 months, disability scores were excellent. Major complications did not occur after the 1-year followup. A frequent and bothersome problem after both surgical treatments is implant-related irritation, resulting in high rates of implant removal, after 1 year. Future research could focus on analyzing risk factors for implant irritation or removal.

Level of Evidence

Level II, therapeutic study.

     

弹性髓内钉固定与外固定支架治疗儿童股骨干骨折疗效比较

目的：比较弹性髓内针与外固定支架治疗儿童股骨干骨折的疗效。方法：2002年9月至2008年8月治疗儿童股骨干骨折共67例,使用弹性髓内针治疗儿童股骨干骨折36例,男23例,女13例,年龄5～11岁,平均（7.1±1.6）岁;外固定支架治疗31例,男19例,女12例,年龄3～12岁,平均（6.5±2.3）岁。所有病例均为闭合复位,对两种不同内固定术后骨折愈合时间、术后并发症进行比较分析。结果：全部病例均获随访,时间9～24个月,平均（12±3）个月。弹性随内针组治疗小儿股骨骨折在骨折临床愈合时间和骨性愈合时间均短于外固定支架组（P〈0.05）。外固定支架组,继发钉道感染5例,骨折延迟愈合3例,再骨折2例,螺钉断裂1例;弹性髓内针组钉尾激惹3例。结论：弹性髓内针治疗儿童股骨干骨折有很大优势,而对高能量骨折及多发伤的病例外固定支架则不失为一种良好的选择,股骨近端和远端骨折尽量避免使用弹性髓内针固定。     

Osteonecrosis of the femoral head after osteosynthesis of a proximal femur fracture with a 95° condylar plate

Summary Avascular necrosis of the femoral head is a frequent complication after osteosynthesis of femoral neck fractures. It is rarely seen after proximal femur fractures with intact trochanteric area. The choice of the implant varies from different blade systems (DHS, DCS and condylar plates) to intramedular nailing systems (gamma nail, classic nail). The complication of avascular necrosis of the femoral head after internal fixation of subtrochanteric and proximal femur fractures is reported following intramedullary nailing. We report a case of a femoral head necrosis after osteosynthesis of a proximal femur fracture with a 95 degree condylar plate.