解剖型锁定钢板固定治疗累及股骨干的转子间或转子下骨折  

Treating femoral intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures using anatomic locking plate

作　　者：王少林[1] 谭祖键[1] 周明全[1] 吴钢[1] 张胜利[1] 龙祥明[1] 

机构地区：[1]重庆市中山医院骨科,400013

出　　处：《中华骨科杂志》2012年第7期626-630,共5页Chinese Journal of Orthopaedics

基　　金：重庆市卫生局医学科研计划项目（2011-2-371）

摘　　要：目的评价采用解剖型锁定钢板固定治疗累及股骨干的转子间或转子下骨折的临床疗效。方法2009年1月至2011年6月，采用解剖型锁定钢板固定治疗累及股骨干的转子间或转子下骨折者72例，64例患者获得随访。男50例，女14例；年龄21-79岁，平均42．8岁。所有患者均为股骨单侧闭合性骨折。受伤至手术时间间隔为2h^16d，平均4．6d。术后第1、3、6、9、12个月门诊随访，以后每年至少门诊复查一次。随访时所有患者均拍摄股骨正、侧位X线片。临床疗效评价采用Harris髋关节功能评分标准。结果64例患者手术时间45-120min，平均65min；术中出血量50-650ml，平均210ml。所有患者均于术后3-15d可下地扶拐行走。随访期间所有患者均未出现感染、下肢静脉血栓、螺钉切割股骨头及断钉现象，2例患者出现髋内翻短缩畸形，无骨折不愈合患者。骨折愈合时间为3．6～10．5个月，平均5．2个月。按Harris髋关节功能评分标准：优45例，良14例，可5例，优良率为92．19％（59／64）。结论解剖型锁定钢板固定治疗方法具有微创、固定强度高、生物力学特性佳等特点，在治疗累及股骨干的转子间或转子下骨折时具骨愈合率高、功能恢复快、并发症少等优点。Objective To evaluate clinical efficacy of treating femoral intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures using anatomic locking plate. Methods From January 2009 to June 2011, we treated 72 cases of femoral intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures using anatomic locking plate. Sixty-four cases were followed up. There were 50 males and 14 female, with an average age of 42.8 years （range, 21-79）. All patients suffered from closed femoral unilateral fractures. The interval between injury and surgery was 2 h-16 d （average, 4.6 d）. All patients were followed up at regular interval. During the follow-up period, clinical and radiographic data were recorded. The clinical efficacy was evaluated with Harris hip function score. Results The mean operative time was 65 min （range, 45-120 min）; the mean blood loss was 210 ml （range, 50-650 ml）. All patients began to walk with crutches 3-35 d after surgery. During the follow-up period, no infection, deep vein thrombosis, screwed cut-out and implant failure occurred in all patients. Coxa vara with shortening deformity was noted in 2 cases, solid bone union was found in all the cases. The mean time of fracture healing was 5.2 months （range, 3.6-10.5 months）. According to Harris hip score, 45 cases were classified as excellent, 14 as good and 5 as fair, with excellent and good rate being 92.19% （59/64）. Conclusion Anatomic locking plate fixation provides stable fixation, with a high union rate and a minimal complication rate in treatment of intertrochanteric and subtrochanteric fractures combined with femoral shaft fracture.

关 键 词：股骨骨折 骨折固定术 内固定器 

分 类 号：R687.3[医药卫生—骨科学]