经皮有限切开新型微创动力髋钢板治疗股骨转子下骨折  

Treatment of subtrochanteric femur fractures with minimal invasion dynamic hip plate through percutaneous limited open reduction

作　　者：翁益民[1] 孔建中[1] 潘骏[1] 水小龙[1] 冯永增[1] 郭晓山[1] 

机构地区：[1]温州医学院附属第二医院骨科,325000

出　　处：《中华创伤杂志》2013年第4期325-329,共5页Chinese Journal of Trauma

基　　金：温州市科技局基金资助项目（Y20090191）

摘　　要：目的探讨应用新型微创动力髋钢板（minimal invasion dynamic hip plate，MIDHP）经皮小切口治疗股骨转子下骨折的可行性、手术方法、临床疗效及手术适应证。方法所有患者均用新型MIDHP行经皮小切口手术治疗。记录患者手术时间、术中出血量、切口长度、术中及术后有无发生相关并发症。术后定期复查x线片，观察是否发生骨折移位、固定松动、螺钉在股骨颈内切割、螺钉穿透股骨头及退出，内固定是否发生弯曲、折断及骨折愈合情况。根据黄公怡关节功能评定标准评价术后髋关节功能。结果手术时间45～65min，平均50min；手术切口长度4．0—5．0cm，平均4．5cm；术中出血量50～200ml，平均150ml。本组21例均获随访，时间6—28个月，平均18个月。随访过程中未见内固定松动、弯曲、骨折移位，未见螺钉切割、退出及穿透股骨头，未发生切口及骨、关节感染。本组患者术后3个月均获得骨性愈合，骨折愈合率达100％。髋关节功能评定结果：优19例，良2例。结论用新型MIDHP行经皮小切口手术治疗股骨转子下骨折具有损伤小、切口短、术中出血少、术后并发症少、固定牢固、髋关节功能恢复良好等优点。适用于不同类型股骨转子下骨折，尤其是伴有骨质疏松的患者。Objective To investigate the possibility, surgical methods, outcome and surgical in- dications of minimal invasion dynamic hip plate （MIDHP） through percutaneous limited open reduction in treatment of subtrochanteric femur fractures. Methods All cases underwent percutaneous limited open reduction with MIDHP. Duration of operation, intraoperative bleeding volume, length of incision, inci- dence of intra- or post-operative complications of all case were recorded. X-ray films were reviewed peri- odically after operation to analyze aspects of fracture displacement, loosening of internal fixation, screw cutting femoral neck, screw penetrating out of or withdrawing from femoral head, bending or breaking of internal fixation, and fracture healing. Hip joint function was evaluated according to Huang＇ s criteria. Results Operation lasted for 45-65 minutes （average 50 minutes）, showing the incision length of 4.0- 5.0 cm （average 4.5 cm） and blood loss of 50-200 ml （average 150 ml）. A total of 21 cases were en- rolled in the study and were followed up for 6-28 months （average 18 months）. In the follow-up, loose- ning or bending of internal fixation, fracture displacement, screw cut-out, and screw penetrating or with- drawing from femoral head did not occur. In the meantime, incision, bone, and joint were not infected. All cases had bony fusion within 3 months with the fracture healing rate of 100%. According to Huang＇ s criteria, hip function was excellent in 19 cases and good in two. Conclusions MIDHP with percutane- ous limited open reduction is characterized by less trauma, small incision, less blood loss, less postopera- tive complications, firm fixation, early functional exercise, free load ,and good hip functional recovery and hence is suitable for cases of different subtrochanteric femur fractures, especially for cases comlfined with osteoporosis.

关 键 词：股骨骨折 骨折固定术 内 内固定器 

分 类 号：R687.3[医药卫生—骨科学]