老年股骨转子间骨折内固定失效的原因探讨  

Causes for failed internal fixation of femoral intertrochanteric fracture in senile patients

作　　者：乔晓光[1] 张雪华[1] 孙贵耀[1] 曹雨[1] 杨永合 樊涛[1] 于海峰[1] 王贵宾[1] 张薇[1] 

机构地区：[1]北京市朝阳区双桥医院骨科,100121

出　　处：《中华创伤杂志》2015年第5期439-442,共4页Chinese Journal of Trauma

摘　　要：目的 探讨老年股骨转子间骨折内固定失效原因及应对措施. 方法 选择2008年9月-2014年6月行不同内固定手术治疗的96例股骨转子间骨折患者,其中男42例,女54例;年龄65 ～98岁,平均72.5岁.根据Evans分型,Ⅰ型19例,Ⅱ型32例,Ⅲ型25例,Ⅳ型16例,Ⅴ型4例.分析骨折内固定失效原因、内固定方式、内固定失效类型及发生率情况.根据手术方式分为股骨近端髓内钉（PFN）组（13例）、股骨近端防旋髓内钉（PFNA）组（31例）、解剖钢板组（19例）、锁定接骨板组（25例）和动力髋螺钉（DHS）组（8例）. 结果 96例均获得随访,时间3 ～ 36个月（平均11.8个月）.术后9例出现内固定失效,其中稳定骨折内固定失效2例,不稳定骨折内固定失效7例,发生率为9％.失效类型：PFN组0例,PFNA组2例,解剖钢板组3例,锁定接骨板组8例,DHS组l例.失效原因：术式选择不当出现髋内翻、短缩畸形,术中螺钉未拧紧以及过早负重导致内固定物断裂或松动. 结论 老年股骨转子间骨折内固定失效与老年骨质疏松、内固定方式选择不当、操作不当及术后功能锻炼欠合理有关.Objective To investigate the causes and countermeasures of failed internal fixation of femoral intertrochanteric fracture in the senile patients.Methods From September 2008 to June 2014,96 patients with femoral intertrochanteric fracture were operated on using varied internal fixations These patients were 42 males and 54 females in age range of 65-98 years （mean,72.5 years）.There were 19 Evans type Ⅰ,32 type Ⅱ,25 type Ⅲ,16 type Ⅳ and 4 type Ⅴ fractures.Internal fixation methods,failure causes as well as types,and failure incidence were analyzed.Results All the patients were followed up for 3 to 36 months （mean,11.8 months）.Totally 9 patients resulted in failed internal fixation,with the failure rate of 9% （2 stable and 7 unstable fractures）.Failed internal fixations were proximal femoral nail antirotation （PFNA,n =2）,anatomic plate fixation （n =3）,locking plate osteosynthcsis （n =8） and dynamic hip screw （n =1）.Failure types were hip varus and shortening deformity because of incorrect operation and internal fixation breakage or loosening as the screws were not tightened during operation.Conclusion Osteoporosis,incorrect internal fixation methods,faulty operative procedures and postoperative rehabilitation are the most important factors responsible for the internal fixation failure for femoral intertrochanteric fracture in senile patients.

关 键 词：股骨骨折 骨折固定术 内 内固定失效 

分 类 号：R687.3[医药卫生—骨科学]