股骨转子间骨折术后内固定失效的再次内固定治疗

目的 评价股骨转子问骨折术后内固定失效行再次内固定加自体髂骨植骨术的疗效. 方法回顺性研究2000年1月至2008年3月间收治的股骨转子问骨折术后内固定失效、骨折不愈合病例31例,其中25例接受切开复位重新内固定加自体髂骨植骨术.一期失效的内固定种类包括动力髋螺钉12例,髁钢板3例,角钢板1例,带锁髓内针3例和空心钉6例.根据遗留骨质状况以及骨折类型选择更换的内固定物,包括股骨近端髓内钉12例,动力髁螺钉7例,动力髋螺钉4例和角钢板2例.所有患者均行自体髂骨植骨. 结果随访时间6-84个月,平均24个月.平均手术时间200 min(120～240 rain),平均出血量1500 mL(800～3000 mL).术中和术后无严重并发症发生.骨折愈合24例,愈合率为96.0%(24/25).25例患者术后髋关节Harris评分平均87分(35～100分),优良率为76.0%.随访患者X线片测量颈十角平均120.(110°～140°),无股骨头缺血坏死表现及髋关节退行性改变. 结论对于股骨转子间骨折术后内固定失效的患者,股骨近端只要存在可固定的骨质,患者的髋关节无严重损害,再次内固定加植骨治疗能够获得满意的临床结果.

Salvage of failed internal fixation for intertrochanteric hip fractures

Objective To evaluate the secondary internal fixation plus bone grafting for salvage of failed internal fixation for intertrochanteric hip fractures. Methods Between January 2001 and March 2008, 25 patients with intertrochanteric fractures who had suffered from failed initial internal fixation were treated with secondary open reduction and internal fixation and bone auto grafting. They were 15 men and 10 women, with a mean age of 50 (17 to 72) years. The mean interval between the initial operation and the revision was 12 (4 to 27) months. The failure of original internal implants involved the dynamic hip screw (DHS) in 12 patients, the dynamic condylar screw (DCS) in 3, the angular blade plate (ABP) in 1, the cephalomedullary nail in 3 and the cannulated screw in 6. The replacement of internal implants included PFN in 12 eases, DCS in 7, DHS in 4 and ABP (95°) in 2. Results The mean follow-up was 24 (6 to 84) months. The revisions were uneventful. Of the 25 nonunions, 24 healed (96.0%). The postoperative mean hip rating (Harris score) for the hip joint was 87(35 to 100) points. The X-ray films at the last follow-up revealed the coLlodiaphyseal angle averaged 120° ( 110° to 140°). No avascular necrosis of the femoral head or hip degeneration was found. Conclusion In properly selected patients, secondary internal fixation with bone grafting for failed open reduction and internal fixation of intertrochanteric hip fractures can provide a high rate of union and good clinical results with a low rate of complications.