倒置微创锁定接骨板与髓内钉治疗股骨转子部骨折疗效对比分析

 目的 比较倒置使用微创锁定接骨板(less invasive stabilization system，LISS)与髓内固定治疗股骨近端转子部骨折的疗效。方法 回顾性分析2004年3月至2011年5月采用倒置LISS或髓内固定系统治疗362例股骨转子部骨折患者资料，其中采用倒置LISS固定70例(倒置LISS固定组)，男32例，女38例；年龄45～87岁，平均73.4岁。采用髓内固定系统治疗292例(髓内固定组)，男125例，女167例；年龄14～96岁，平均74.7岁。比较两组患者手术时间、术中出血量及住院时间、骨愈合情况、术后并发症发生率及关节功能。结果 倒置LISS固定组手术时间、术中出血量、住院时间分别平均为120 min、100 ml、12 d，髓内固定组分别平均为80 min、100 ml、10 d。倒置LISS固定组术后3例发生下肢深静脉血栓栓塞，髓内固定组术后10例发生下肢深静脉血栓栓塞、3例发生肺栓塞。倒置LISS固定组63例、髓内组257例获得随访，平均随访时间26.9个月。术后髋关节Harris评分，倒置LISS固定组为平均为75分，优良率42.9%(27/63)；髓内固定组为平均77分，优良率41.6%(107/257)。倒置LISS固定组术后7例出现螺钉断裂，并发症发生率为11.1%(7/63)；髓内固定组2例发生髋螺钉退出、9例发生螺钉穿入髋臼，并发症发生率为4.3%(11/257)。髓内固定组内固定相关并发症发生率明显低于倒置LISS固定组。结论 倒置LISS和髓内固定均能有效治疗转子部骨折，术后髋关节功能二者无显著差异。倒置LISS术后内固定相关并发症发生率高于髓内固定。

Reversed less invasive stabilization system versus intramedullary fixation devices for femoral trochanteric fractures

Objective To compare the efficacy of reversed less invasive stabilization system (LISS) and intramedullary fixation devices for treatment of femoral trochanteric fractures. Methods Data of 362 consecutive patients with femoral trochanteric fractures who were treated with reversed LISS or intramedullary fixation devices at our institution between March 2004 and May 2011 were retrospectively analyzed. There were 32 males and 38 females treated with reversed LISS. The mean age at injury was 73.4 years. There were 125 males and 167 females treated with intramedullary fixation. The mean age at injury was 74.7 years. The operation time, intraoperation blood loss and length of hospitalization were compared. The patients were asked to fill in a questionnaire of Harris hip score, and radiographs were used to evaluate the bone healing situation. Results The mean operation time was 120 min in reversed LISS group and 80 min in intramedullary group. The length of hospitalization was 12 days in reversed LISS group and 10 days in intramedullary group. More operation time and longer length of hospitalization were needed in reversed LISS group. The intraoperation blood loss was 100 ml in reversed LISS group and 100 ml in intramedullary group. There were 3 DVT in reversed LISS group, 10 DVT and 3 PE in intramedullary group. No difference was found in the aspect of intraoperation blood loss, postoperative deep venous thrombosis and pulmonary embolism rate. A total of 320 patients were successfully followed-up, including 63 in LISS group and 257 in intramedullary group. The median Harris score was 75 in LISS group and 77 in intramedullary fixation group respectively. There was no difference of hip function score between two groups. The implant-related complication rate was 11.1% in reversed LISS group, including 7 implant breakages. In intramedullary fixation group, there were neck screw exiting in 2 patients and cutout in 9 patients. So the implant-related complication rate was 4.3% in intramedullary fixation group, which is statistically lower. Conclusion Both reversed LISS and intramedullary are effective for the treatment of proximal femoral fractures. There were no major difference in functional outcome between LISS and intramedullary nail. Intramedullary nail is still the choice of priority in most unstable proximal femoral fractures. The implants related complications in reversed LISS group are higher than Intramedullary nail group. However, for the unstable fractures proximal femoral fractures with lateral wall fracture, in which nailing may be difficult, reversely using LISS may be a good alternative.