解剖学锁定钢板治疗股骨近端骨质疏松性骨折的疗效分析  

Clinical outcomes of treating osteoporotic fractures of proximal femora with anatomical locking plate

作　　者：赵宝成[1] 张金利[1] 袁天祥[1] 马宝通[1] 

机构地区：[1]天津市天津医院创伤骨科,天津300211

出　　处：《中国矫形外科杂志》2015年第6期518-523,共6页Orthopedic Journal of China

摘　　要：[目的]探讨解剖学锁定钢板治疗股骨近端骨质疏松性骨折的疗效。[方法]回顾分析自2009年2月~2012年11月120例采用解剖学锁定钢板治疗的股骨近端骨质疏松骨折患者病例资料。其中,男46例,女74例;平均年龄73岁（19~94岁）。新鲜骨折118例,陈旧骨折2例。左侧86例,右侧34例。转子间骨折90例,转子下骨折30例。76例存在内科合并症,手术距受伤时间平均10.7 d（5~134 d）。[结果]平均随访25.5个月（12~55个月）。平均手术时间2.1 h（1~5.5 h）,术中平均出血量567 ml（100~4 500 ml）。术后离床逐步负重时间平均5.5周,完全负重活动时间平均12.2周。骨折愈合时间平均17.6周（10~150周）。Sanders评分平均51分（21~58分）,优良率83.3%。闭合复位75例,切开复位45例。切开复位组比闭合复位组手术时间明显延长,术中失血量显著增加。并发症共计43例,其中,大转子部位疼痛38例,骨折愈合问题11例,内固定失败2例,感染3例。[结论]股骨近端锁定钢板固定可靠、愈合率高,是治疗股骨近端骨质疏松骨折的有效方法之一。良好复位、准确放置钢板及抗骨质疏松治疗是获得满意临床疗效,降低并发症的前提。[Objective]To evaluate the clinical outcome of treating osteoporotic fractures of proximal femora with proximalfemoral anatomical locking plate. [Method]From Feb. 2009 to Nov. 2009,120 patients with osteoporotic intertrochanteric and subtrochanteric fracture of femur treated with proximal femoral anatomical locking plate were retrospectively studied.There were 74 females,46 males,with an average age of 73years（ 19 ~ 94 years）. Among them,118 cases were acute and 2 chronic with 86 in left hip and 34 in right side. They were 90 intertrochanteric and 30 subtrochanteric fractures respectively. Seventy-six patients had medical comorbidities. The operation was carried out with an average duration of 10. 7 days（ 5 ~ 134days） after initial injury. [Result]All patients were followed up for an average of 25. 5 months（ 12 ~ 55 months）. The mean operating time was 2. 1 hours（ 1 ~ 5. 5 hours） and blood loss averaged 567ml（ 100 ~ 4 500 ml）. Partial and complete weight bearing average time commenced at an average of 5. 5 weeks and 12. 2 weeks after operaton respectively. Bone healing was achieved after an average of 17. 6 weeks（ 10 ~ 150 weeks）. The mean Sanders score was 52 scores（ 21 ~ 58） with 83. 3% of excellence and good results rate. Indirect reduction was succeeded in 75 patients,and open reduction in 45 cases. The operative time and blood loss in operation in open reduction group were increased significantly compared with that of indirect reduction group. There were 43 patients documenting complications,comprising great trochanter site pain in 38 cases,bone healing problem 11,hardware failure 2,infection 3. [Conclusion]Proximal femoral anatomical locking plate may be an effective alternative for osteoporotic fractures of proximal femora with reliable stability and high union rate. Optimal reduction,accurate placement of plate,and anti- osteoporotic therapy are prerequisites for maximizing good result and minimizing complications.

关 键 词：髋部骨折 骨质疏松 内固定 锁定钢板 治疗 

分 类 号：R687.3[医药卫生—骨科学]