大粗隆钢板治疗Vancouver AG型股骨假体周围骨折的近期临床疗效分析

目的探讨大粗隆钢板（GTR，Zimmer）治疗大粗隆粉碎的VancouverA。型股骨假体周围骨折的近期临床疗效。方法自2010年1月-2013年6月共收治12例Vancouver AG型股骨假体周围骨折患者，均采用大粗隆钢板进行切开复位内固定治疗。记录手术时间、出血量、大粗隆骨折骨性愈合时间、术后并发症，有无内固定装置松动、感染发生率，同时对术前术后髋关节Harris评分进行统计学分析。结果所有患者均有完整随访资料，随访时间6～30（19．0±6．4）个月。12例患者大粗隆均骨性愈合，平均愈合时间（4．2±1．1）个月。平均手术时间（52．1±6．2）min，平均出血量（183．3±40．1）ml。术前术后Harris评分分别为（47．1±10．3）分和（93．8±2．5）分（P〈0．05）。1例术后发生下肢深静脉血栓，其余病例无严重并发症发生。至随访结束，无一例内固定装置松动，无一例线缆断裂，无感染病例。结论采用大粗隆钢板治疗大粗隆粉碎的VancouverAG型股骨假体周围骨折能够达到解剖复位，特别是大粗隆骨折呈粉碎型，骨折固定可靠，可恢复外展肌功能，对骨膜血运损伤小，利于骨折愈合，并发症少，可早期功能锻炼，关节功能恢复好，其近期临床疗效满意。

Treatment of Vancouver type AG periprosthetic femoral fracture with greater trochanter reattachment

Objective To analyze the therapeutic effect of greater trochanter reattachment device （GTR, Zimmer） on Vancouver type AG periprosthetic femoral fracture with comminuted greater trochanter. Methods A total of 12 patients with Vancouver type AG periprosthetic femoral fracture with comminuted greater trochanter from January 2010 to June 2013 were selected. They were all treated with open reduction and internal fixation by using greater trochanter reattachment device. Operation time, intraoperative blood loss, bony union, complications, prosthesis stability and infection rate were recorded. Harris score was used to evaluate hip function before and after operation. Results All the patients were followed-up for 6 - 30 （ 19.0 ± 6.4） months after operation. All the fractures reached union, with an average time of （4.2 ± 1.1 ） months. The average operation time was （52.1 ± 6.2） minutes, and the averae intraoperative blood loss was （ 183.3 ± 40.1 ） ml. There was a significant difference in Harris hip score between pre- and post-operation （47.1 ± 10.3 vs 93.8 ± 2.5 ） （ P 〈 0.05 ）. All the patients did not encounter complications except one who suffered from deep vein thrombosis. There were no infection and loosing fixation. Conclusion With the advantages of anatomical reduction, rigid fixation, less complications, good recovery of the hip function and satisfactory results in short period, greater trochanter reattachment device is applicable to Vancouver type Ac periprosthetic femoral fracture with comminuted greater trochanter.