股骨近端锁定接骨板治疗特殊类型股骨近端骨折

背景：应用髓内固定系统规范化治疗股骨近端骨折已得到临床上的广泛共识,但是对于某些特殊类型的股骨近端骨折如股骨转子下骨折、股骨近端外侧壁不完整等的治疗仍较困难。目的：探讨股骨近端锁定接骨板（LPFP）治疗特殊类型股骨近端骨折的疗效。方法：2012年5月至2014年5月应用LPFP治疗特殊类型股骨近端骨折22例,其中股骨转子间骨折伴股骨近端外侧壁不完整9例（Evans-Jensen分型：Ⅲ型5例,Ⅴ型4例）;股骨转子下骨折10例（Seinsheimer分型：ⅡA型2例,ⅡB型2例,ⅢB型4例,Ⅴ型2例）;股骨颈骨折伴股骨转子下骨折2例,股骨转子间骨折伴股骨上段骨折1例。所有患者均采用LPFP内固定术,记录手术时间、术中出血量、术后并发症、骨折愈合时间和术后髋关节功能评分。采用Harris评分评估髋关节功能情况。结果：手术时间为65~150 min,平均96 min;出血量为80~750 ml,平均360 ml。22例全部获得随访,随访时间为3~27个月,平均12.8个月。1例患者在术后4个月发生锁钉断裂,2例发生延迟愈合,无一例出现切口感染和深静脉血栓。骨折愈合时间为2~20个月,平均3.2个月。髋关节Harris评分为78~99分,平均86分。结论：LPFP治疗股骨转子下骨折、股骨近端外侧壁不完整等特殊类型股骨近端骨折,具有创伤小、安全性高等特点,是髓内固定治疗股骨近端骨折的有益补充。

Treatment of special proximal femoral fractures with proximal femur locking plate system

Background： It is widely recognized to treat proximal femoral fractures with intramedullary intemal fixation system in clin- ic. However, there are some difficulties to deal with some special type proximal femoral fractures such as subtrochanteric fractures and intertrochanteric fractures with lateral wall fracture. Objective： To explore the clinical outcome of locking proximal femoral plate （LPFP） in treatment of special proximal femo- ral fractures. Methods： A total of 22 patients with special proximal femoral fractures were treated with LPFP from May 2012 to May 2014. Nine cases suffered from intertrochanteric fractures with lateral wall fracture （Evans-Jensen classification： type Ⅲ in five and type V in four）, 10 with subtrochanteric fractures （type Ⅱ A in two, type Ⅱ B in two, type Ⅲ B in four and type V in two according to Seinsheimer classification）, 2 with femoral neck fracture and subtrochanteric fracture, 1 with trochanteric fracture and proximal femoral shaft fracture. Operation time, intraoperative blood loss, postoperative complications, fracture healing time and postoperative hip function score were recorded. Hip joint function was evaluated by Harris scoring system. Results： The operation lasted for 96 min on average （range, 65-150 min）. Intraoperative blood loss was 360 ml （range, 80- 750 ml）. The mean duration of follow-up was 12.8 months in all patients （range, 3-27 months）. Proximal locking screw broke up in one patient with type Seinsheimer V fracture 4 months postoperatively. Delayed union happened in two cases. No infection of incisional wound or deep vein thrombosis occurred. The mean healing time of fracture was 3.2 months （range, 2-20 months）. The Harris score of hip joint was 86 （range, 78-99）. Conclusions： LPFP has advantages of minor invasion, better safety for treatment of special proximal femoral fractures,which is the beneficial supplement to intramedullary fixation.