摘要
目的比较股骨转子间骨折采用髓外与髓内固定系统治疗,术后发生固定失效病例的原因、翻修方法、效果分析,及对术后早期康复的临床指导意义。方法回顾性分析2010年1月~2014年12月我院采用髓外系统治疗的489例股骨转子间骨折中内固定失效的12个病例,翻修措施包括4例卧床休息达到骨折愈合,4例拆除髓外系统改行髓内系统翻修,2例行人工全髋关节置换术（THR）翻修,2例行人工股骨头置换术（AFHR）翻修。采用髓内系统治疗的423例股骨转子间骨折中,其中内固定失效共3例,2例翻修为全髋关节置换术（THR）,1例翻修为人工股骨头置换术（AFHR）翻修。结果经过翻修手术,髓外系统治疗的12例（失效率0.71%）内固定失效患者,术后平均随访（8.8±1.9）个月,和髓内系统治疗3例（失效率为2.45%）内固定失效患者,术后平均随访（9.4±1.7）个月,全部病例均达到骨性愈合,且未发生切口深部感染、假体松动、脱出及断裂、假体周围骨折等并发症。髓外组愈合时间为（8.5±1.0）个月,髓内组愈合时间为（6.7±0.3）个月,组间比较差异有统计学意义（t=5.50,P〈0.05）。髓外组Harris评分（78.67±7.81）,髓内组Harris评分（86.38±5.17）,组间比较差异无统计学意义（t=-2.16,P〉0.05）。结论髓外、髓内系统治疗股骨转子间骨折,髓内系统的失效率更低,经过翻修术,髓内系统的效果优于髓外系统。
Objective To analyze the reasons, rebuilding methods and effects of extramedullary and intramedullary fixation failure in intertrochanteric fracture and its clinical significance to early postoperative rehabilitation. Methods A total of 12 cases of internal fixation failure among 489 cases of intertrochanteric fracture adopting extramedullary systemic therapy from January 2010 to December 2014 were reviewed and analyzed. Measures of rebuilding included bed rest till fracture healing（4 cases）, removing extramedullary system and rebuilding intramedullary system（4 cases）,total hip replacement（THR, 2 cases）, and artificial femoral head replacement（AFHR, 2 cases）. Another 3 cases of internal fixation failure among 423 cases of intertrochanteric fracture adopting intramedullary systemic therapy duing the same time period were also enrolled and the measures of rebuilding in these cases were THR（2 cases） and AFHR（1 case）. Results 12 patients（failure rate=0.71%） of internal fixation failure in extramedullary systemic therapy were followed up for（8.8±1.9） months after rebuilding, and the 3 patients（failure rate was 2.45%） of internal fixation failure in intramedullary systemic therapy were followed up for（9.4±1.7） months after rebuilding. Fracture healing were ob served in all patients without complications such as deep infection of incision, prosthetic loosening, extrusion or breakage,and peri-prosthetic fracture. The healing time of the extramedullary group was（8.5 ±1.0） months, and the healing time of the intramedullary group was（6.7 ±0.3） months; The difference was significant（t =5.50,P〈0.05）. The Harris score was（78.67±7.81） in the extramedullary group,and（86.38±5.17）in the intramedullary group, which was not significantly different（t=-2.16, P〉0.05）. Conclusion The failure rate of intramedullary therapy is lower than that of extramedullary therapy in treatment of intertrochanteric fracture and the effect after rebuilding is superior in intramedu
出处
《中国现代医生》
2016年第9期53-57,共5页
China Modern Doctor
基金
浙江省科技厅中西医结合骨关节病研究科技创新团队项目(2011R50022-05)
关键词
股骨转子间骨折
髓外固定
髓内固定
失效
康复
Intertrochanteric fracture
Extramedullary
Intramedullary
Failure
Rehabilitation
