股骨近端锁定板固定治疗老年不稳定型股骨转子间骨折  

Treatment for unstable intertrochanteric fractures with proximal femoral locking plate in elderly pa- tients

作　　者：熊蠡茗[1] 胡益强 邵增务[1] 曹发奇[1] 刘国辉[1] 夏天[1] 刘毅[1] 刘梦非[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院骨科,武汉430022

出　　处：《中华创伤骨科杂志》2017年第2期115-120,共6页Chinese Journal of Orthopaedic Trauma

基　　金：国家重点研发计划（2016YFC1100100）;国家自然科学基金（81572204）;湖北省科技支撑计划（2015BHE014）

摘　　要：目的探讨股骨近端锁定板（PFLP）固定治疗老年不稳定型股骨转子间骨折的疗效。方法回顾性分析2010年1月至2015年6月期间采用PFLP固定且获得随访的380例老年不稳定型股骨转子间骨折患者资料。男171例，女209例；年龄为60-89岁，平均68．7岁。骨折AO分型：31-A2．2型58例，31-A2．3型87例；31-A3．1型130例，31-A3．2型63例，31-A3．3型42例。记录患者的手术时间、切口长度、住院时间、骨折愈合时间、术后并发症发生率及髋关节Harris评分等。结果380例患者术后获8-21个月（平均13．3个月）随访。本组患者的手术时间平均为53．2min，术中X线透视次数平均为12．2次，术中出血量平均为92．7mL，切口长度平均为12．6cm，术后引流量平均为54．7mL，住院时间平均为9．2d。术后并发症：肺部感染3例，内固定物松动8例，内固定物断裂2例，髋内翻畸形9例，骨折不愈合4例，并发症发生率为6．8％（26／380）。无一例患者发生切口感染。380例患者骨折愈合时间平均为11．8周（7-48周）。术后1年患者髋关节Harris评分平均为（86．3±6．1）分，与术前[（43．6±4．4）分]比较差异有统计学意义（P〈0．05）；优96例，良231例，可42例，差11例，优良率为86．1％。结论PFLP固定术具有创伤小、术中出血量少、术后并发症少、骨折愈合率高及髋关节功能恢复好等优点，是治疗老年不稳定型股骨转子间骨折的较好选择。Objective To explore the clinical outcomes of treating unstable intertrochanteric frac- tures with proximal femoral locking plate （PFLP） in the elderly patients. Methods From January 2010 to June 2015, 380 elderly patients with unstable intertrochanteric fracture were treated with PFLP and success- fully followed up at our department. They were 171 men and 209 women, from 60 to 89 years of age （average, 68.7 years） . By AO classification, there were 58 cases of AO31-A2.2, 87 ones of 31-A2.3, 130 ones of 31-A3.1, 63 ones of 31-A3.2, and 42 ones of 31-A3.3. Operation time, incision length, length of hospital stay, fracture healing time, postoperative complications and hip joint Harris scores were recorded. Results This cohort was followed up for an average of 13.3 months （range, from 8 to 21 months）. Their operation time averaged 53.2 min, X-ray exposure 12. 2 times, intraoperative blood loss 92.7 mL, incision length 12. 6 cm, postoperative drainage volume 54.7 mL, and length of hospital stay 9.2 days. Pulmonary infection was ob- served in 3 cases, fixation loosening in 8, fixation breakage in 2, hip varus in 9, and fracture nonunion in 4, yielding a total complication rate of 6. 8% （26/380） . No operative incision infection was observed. The average fracture healing time was 11.8 weeks （range, from 7 to 48 weeks） after operation. The average Harris score one year postoperation for the 380 patients was 86. 3 ± 6. 1, significantly higher than the pre- operative value （43.6 ±4.4） （P 〈 0. 05） . There were 96 excellent, 231 good, 42 fair and 11 poor cases, giving an excellent to good rate of 86. 1%. Conclusion Since PFLP has advantages of limited invasion, blood loss and complications, a high rate of fracture healing, and good functional recovery of thehip, it may be a good treatment for unstable intertrochanteric fractures in the elderly patients.

关 键 词：髋骨折 骨折固定术 内 骨板 外科手术 微创性 

分 类 号：R687.3[医药卫生—骨科学]