股骨近端外侧加压型锁定板治疗转子间不稳定性四部分骨折

目的评价股骨近端外侧加压型锁定板治疗转子间不稳定性四部分骨折的临床疗效。方法对我科自2005年7月至2010年5月收治的53例股骨转子间不稳定性四部分骨折患者进行回顾性分析。全部患者均采用股骨近端外侧加压型锁定板固定,运用颈干角、尖顶距等影像学测量指标和髋关节Harris评分评价其治疗效果。结果 52例患者获得平均9.1个月的随访,均获得骨折愈合。复位好的49例,可以接受的复位2例,复位差的1例。术后颈干角为93°～138°,平均129°;尖顶距〈25mm的47例,尖顶距≥25mm的5例。术后并发症包括髋内翻2例,损伤性骨化1例,大腿痛2例。按Harris评分标准,优29例,良19例,可3例,差1例,优良率为92.3%。结论股骨近端加压型锁定板具有符合股骨近端解剖形态、固定牢固、可抗旋转、手术灵活安全、手术时间短、失血量少及对股骨头血供干扰小等优点,是一种较好的固定转子间不稳定性四部分骨折的内置物。

Application of proximal femur locking compression plate for unstable four-part intertrochanteric fractures

Objective To evaluate the clinical results of proximal femur locking compression plate（LCP） for unstable four-part intertrochanteric femoral fractures. Methods Clinical data of 53 patients with unstable four-part intertrochanteric fractures from July 2005 to May 2010 were analyzed retrospectively. All the cases were treated with proximal femur LCP. The results were assessed radiographically according to the neck-shaft angle of the femur （collodiaphysial angle） and the tip-apex distance. Clinical evaluation was made using the Harris hip score. Results Fifty-two patients were followed up for an average of 9.1 months （range from 3 months to 24 months）. Union was obtained in all the patients. Reduction was good in 49 patients, acceptable in 2 patients, and poor in 1 patient. The mean collodiaphysial angle was 129° （range 93° to 138°）. There were 47 patients whose tip-apex distances were less than 25 mm, and 5 patients whose tip-apex were greater than or equal to 25 mm. Post- operative complications included 2 cases of varus, 1 case of traumatic ossification and 2 cases of meralgia. According to Harris hip score, the results were excellent in 29 patients, good in 19 patients, fair in 3 patients, and poor in one patient, with the excellent-to-good rate 92.3%. Conclusion Considering the anatomic structure of proximal femur, stabilization and anti-rotation function, safety and flexible operation, short operation time, blood loss decrease and less disturbance to blood supply of femur head, proximal femur LCP is a comparable internal fixation device for unstable four-part intertrochanteric femoral fractures.