干骺端加压锁定钢板联合空心钉内固定治疗大龄儿童股骨粗隆下骨折的疗效分析  

Analysis of clinical curative effect of internal fixation with metaphysis end pressure locking plate and hollow screw to treat subtrochanteric femoral fractures of older children

作　　者：陈林 赵友明[2] 王新华[2] 郭伟军[2] 

机构地区：[1]温州市中心医院骨科,浙江325000 [2]温州医科大学附属第二医院创伤骨科

出　　处：《中国骨与关节损伤杂志》2015年第2期148-150,共3页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨干骺端加压锁定钢板联合空心钉内固定治疗大龄儿童股骨粗隆下骨折的临床疗效。方法自2007-08—2011-08采用切开复位干骺端加压锁定钢板联合空心钉内固定治疗大龄儿童新鲜、单侧闭合性股骨粗隆下骨折18例。直视下复位成功后用克氏针临时固定,选用大小合适的干骺端加压锁定钢板根据股骨近端角度预弯,将钢板贴伏于股骨外侧,在近端钢板孔内用1或2枚空心钉导针置入股骨颈长轴方向,依次固定钢板螺钉,并经导针置入空心钉。结果本组手术时间45～80 min,平均55 min。术中出血量60～150 ml,平均70 ml。手术切口6～10 cm,平均7 cm。18例均获得完整随访,随访时间12～60个月,平均28个月。所有骨折均获得骨性愈合,骨折愈合时间6～14周,平均8周。均无骨折延迟愈合、骨不连、深部感染、髋内翻、旋转畸形及髋、膝关节功能障碍等并发症发生。其中1例出现双下肢不等长（长度差10 mm）,经延长26个月的随访观察,双下肢恢复等长。末次随访时按髋关节功能Sanders评分评定疗效：优15例,良3例。结论大龄儿童股骨粗隆下骨折的临床治疗较为棘手,切开复位干骺端加压锁定钢板联合空心钉内固定是一种疗效确切的手术治疗方法。Objective To discuss clinical curative effect of internal fixation with metaphysis end pressure locking plate and hollow screw to treat subtrochanteric femoral fractures of older children. Methods From August 2007 to August 2011, 28 older children with subtrochanteric femoral fractures were treated with metaphysis end pressure locking plate and hollow screw, 10 boys and 8 girls, 5 to 14 years old（mean age 9.5 years）. All the selected cases were unilateral closed subtrochanteric fractures. Results This operation time was 45-80 min, average 55 min. Intraoperative blood loss was 60-150 ml, average 70 ml. Incision was 6-10 cm long, 7 cm on average. All 18 cases had complete clinical follow-up for 12-60 months, average 28 months. All 28 cases had healing. Bone healing time was 6 to 12 weeks, average 8 weeks. There were no delay healing,nonunion, deep infection, hip varus, rotation deformity and hip and knee function disorder. The length discrepancy of lower limbs occurred in one patient（length difference 10 mm）, 26 months later, the length of both lower limbs was same. At the final follow-up according to Sanders hip function, 15 cases were excellent, 3 good. Conclusion Open reduction and internal fixation with metaphysis end pressure locking plate and hollow screw in the treatment of older children with subtrochanteric femoral fractures is effective.

关 键 词：股骨粗隆下骨折 干骺端加压锁定钢板 空心钉 内固定 大龄儿童 

分 类 号：R687.3[医药卫生—骨科学]