微创内固定系统治疗严重股骨上段骨折

目的探讨应用微创内固定系统治疗严重股骨上段骨折的可行性和效果。方法 2007年2月至2009年5月收治11例严重股骨上段骨折患者,男7例,女4例,年龄28~45岁,平均年龄38岁。按AO分类,32C3型10例,31A1+32C3型1例,合并脑外伤1例,均为闭合性损伤,伤后5~9 d在骨科牵引床上进行手术。于股骨大转子外侧切口长约4~6 cm,并由此置入AOLISS钢板(左侧股骨LISS倒置右侧,右侧股骨LISS倒置左侧)。术后3 d应用CPM训练膝关节功能,每月一次摄X线片检查骨折愈合情况,术后10~12周骨痂较多、骨折线模糊时间歇扶双杖负重行走。结果全部病人得以随访,随访期3~24个月,平均11个月。切口均一期愈合,10例骨折平均7个月内骨性愈合,1例(31A1+32C3型)患者术后13个月骨折线完全消失而间歇负重行走。膝关节功能均达100°左右(膝关节伸直为0°),按Kolment评分,优8例,良2例,可1例。结论股骨LISS钢板倒置治疗严重股骨上段骨折是一种安全有效的方法,但要严格掌握适应证。

Treatment of Serious Fracture of Proximal Femoral Shaft with Less Invasive Stabilization System

Objective Explore the effects of treatment of serious fracture of proximal femoral shaft with Less Invasion Stabilisation System（LISS）.Methods From February 2007-may 2009,11 patients（7 males,4 females）with proximal femoral shaft fracture were treated with LISS,All fracture according to the AO classification：10 cases was type 32C3,1 case was type 31A1＋32C3.Left femoral LISS were applied to the right proximal femor（right LISS were applied to left）.By the lateral femoral greater trochanter approach.3 days after operation begin to exercise by CPM.Results All patients were followed up for 3 to 24 months and the average time was 11 months.All incision primarily healed.10 cases achieved primary healing within 7 months after operation,and no complication was found.Another case bone-union by X-ray has been found at 13 months postoperatively,The range of knee flexion-extention was 1000.Conclusion It is an ideal therapy to treat the proximal serious femoral fracture with LISS,but the indication was very important.