非接触桥接假体周围骨折钢板固定治疗转子间骨折髓内固定术后钉体周围骨折  

Non-contact bridging periprosthetic plate on treatment of re-fracture around the nail after intramedullary fixation on intertrochanteric fracture

作　　者：孙玉玺 田维[1] 刘兆杰[1] 戚浩天 王宏川[1] 金鑫[1] 贾健[1] Sun Yuxi;Tian Wei;Liu Zhaojie;Qi Haotian;Wang Hongchuan;Jin Xin;Jia Jian(Department of Plevic Trauma,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津市天津医院创伤骨盆科,300211

出　　处：《中华骨科杂志》2021年第21期1553-1560,共8页Chinese Journal of Orthopaedics

摘　　要：目的探讨微创接骨板技术(minimally invasive plate oseoynthesis,MIPO)结合股骨近端非接触桥接假体周围骨折钢板(non-contact bridging periprosthetic plate,NCB.PP)固定治疗股骨转子间骨折髓内固定术后钉体周围骨折的临床疗效。方法回顾性分析2015年10月至2020年1月治疗并获得随访的12例股骨转子间骨折髓内固定术后钉体周围骨折患者资料,男7例,女5例;年龄(74.88±12.1)岁(范围65~83岁);左侧8例,右侧4例;骨折后均采用股骨近端髓内钉(proximal femoral nail,PFN)短钉固定,术后6~36个月后因跌倒致闭合性钉体周围骨折;均为Vancouver B型患者;术前骨密度检查1例骨量正常,10例骨质疏松,1例骨量低下。所有患者均采用MIPO技术复位固定骨折,并以股骨近端NCB.PP固定。比较术后第1天、术后3个月及末次随访时的视觉模拟评分(visual analogue scale,VAS)及术后3个月、末次随时Harris髋关节评分。结果12例患者手术时间(68.7±4.33)min(范围65~75 min);术中出血量(291.67±114.48)ml(范围150~400 ml);术后引流量(79.17±17.17)ml(范围50~100 ml)。骨折复位后,近端使用(3.25±0.96)枚(范围2~5枚)双皮质螺钉固定;其中3例附加捆绑带捆扎固定;3例术中行自体髂骨植骨。12例患者均获得随访,随访时间9~60个月,平均16个月。末次随访时,10例患者骨折愈合,愈合时间(7.75±2.83)个月(范围4~13个月),骨折愈合率为83.3%(10/12)。另外2例患者中,1例为83岁严重骨质疏松患者,术后卧床,随访12个月仍未愈合;1例为68岁患者,术后6个月复查出现骨折断端骨吸收,进行二次手术,给予断端取髂结合异体骨植骨,至术后13个月时骨折部分愈合。术后1周、3个月和末次随访时VAS评分分别为8.00(8.00,9.00)分、2.50(2.00,3.00)分和0.00(0.00,0.75)分,术后1周与术后3个月、术后1周与末次随访、术后3个月与末次随访VAS评分比较,差异均有统计学意义(Z=-3.129、-3.097、-3.134,均P<0.05)。术后3个月及末�Objective To investigate the clinical efficacy of MIPO combined with non-contact bridging periprosthesis fracture plate(NCB.PP)in the treatment of re-fracture around the nail after intramedullary fixation of intertrochanteric fracture.Methods From October 2015 to January 2020,12 patients with re-fracture around the nail after intramedullary fixation of intertrochanteric fracture were treated in our hospital.There were 7 males and 5 females with an average age of 74.88±12.1 years(range,65-83 years old);8 patients on the left side and 4 patients on the right side received short nail of proximal femoral nail(PFN),6-36 months after operation,they fell down and caused closed fracture around the nail body.According to Vancouver classification system,all the patients were Vancouver type B;preoperative bone mineral density examination showed that 1 case had normal bone mass,10 cases had osteoporosis,and 1 case had low bone mass.All patients were treated with minimally invasive plate osteosynthesis(MIPO)technique for reduction and fixation,and fixed with proximal femur NCB.PP.The visual analogue scale(VAS)and Harris hip score at 1 day,3 months and the last follow-up were compared.Results The average operation time was 68.7±4.33 min(range,65-75 min);the average intraoperative blood loss was 291.67±114.48 ml(range,150-400 ml);the average postoperative drainage volume was 79.17±17.17 ml(range,50-100 ml).After fracture reduction,all patients were able to obtain 2-5 bicortical screws fixation,with an average of 3.25±0.96.Among them,3 cases were fixed with additional binding straps;3 cases underwent autologous iliac bone grafting during the operation.All cases were followed up for 9-60 months,with an average of 16 months.At the last follow-up,10 patients had fracture healing,the healing time was 7.75±2.83 months(range,4-13 months),and the fracture healing rate was 83.3%(10/12).Among the other two patients,one was an 83 years old patient with severe osteoporosis,who was bedridden after operation and remained unhealed after

关 键 词：股骨骨折 骨折固定术 髓内 内固定器 

分 类 号：R687.3[医药卫生—骨科学]