锁定钢板系统治疗股骨粗隆间骨折术后髓内钉周围骨折效果

目的探讨应用锁定钢板系统治疗股骨粗隆间骨折术后髓内钉周围骨折的可行性。方法采用锁定钢板系统（LISS或LCP）治疗7例股骨粗隆间骨折术后髓内钉周围骨折（人工关节置换术后假体周围骨折Vancouver分类为B1型骨折）,分为髓内钉全部取出或保留髓内钉主钉两组。术后均随访12个月以上,观察骨折愈合及肢体功能恢复情况。结果 7例病人骨折均顺利愈合,并恢复行走功能。结论使用锁定钢板系统治疗股骨粗隆间骨折术后髓内钉周围骨折,尤其对于原有粗隆间骨折未完全愈合的病人,是一种明智的选择。术中应保留原有的短重建髓内钉主钉,髓内钉侧骨折可以用单层和（或）双层皮质的锁定螺钉固定,必要时可辅助钛缆加强固定的稳定性,治疗结果是满意的。

LOCKING PLATE SYSTEM IN THE TREATMENT OF PERIPROTHETIC FRACTURE FOLLOWING INTRAMEDULLARY NAIL TREATMENT FOR FEMORAL 1NTERTROCHANTERIC FRACTURE

Objective To discuss the feasibility of using the locking plate system （LPS） in the treatment of fracture around the intramedullary nail after treatment of femoral intertrochanteric fracture （FITF）. Methods By applying LPS, seven patients with fracture around the intramedullary nail after surgry for FITF （fracture around the prosthesis after surgery of prosthetic replacement of joint, Vancouver type-B1 fracture） were divided into two groups： removal intramedullary nail group and retention group. A postoperative follow up was conducted for more than 12 months to observe the fracture healing and the recovery of limb function. Results The fractures in the seven patients healed well and returned to walk. Conclusion It is a wise choice to use locking plate system for subsequent peri-prothetic fracture （Vancouver type-B1） following intramedullary treatment for intertrochanteric fracture, especially for those with previously incompletely-healed fracture. The initial main nail had to be reserved. The fracture of intramedullary side can be fixed by unicortical and/or bicortical screws. The titanium cables around the stem can be used to strengthen the fixation.