摘要
目的:探讨股骨近端三角结构重建失效对股骨近端骨折手术治疗失败的影响。方法:回顾性分析2013年1月至2018年12月,采用手术治疗股骨颈或转子间骨折治疗失败的53例患者资料,男26例,女27例;年龄55.13岁(范围,18~94岁);转子间骨折31例,股骨颈骨折22例;钢板螺钉固定18例,空心钉固定13例,髓内钉固定22例。基于股骨近端的力学规律划分出内侧边、外侧边和上侧边,根据术后失败病例的影像学资料,对不同侧边的重建失败因素进行统计学分析。结果:53例患者中,内侧边重建失效19例,外侧边重建失效4例,上侧边重建失效21例,内侧边和外侧边均重建失效2例,内侧边和上侧边均重建失效7例。53例内固定治疗失败患者中,其中31.2%(16/53)因骨折端再移位而致失败,43.4%(23/53)因骨不连而致失败,22.6%(12/53)因股骨头内固定物位置改变而致失败,3.8%(2/53)因内固定断裂而致失败。统计结果提示,骨折患者不同侧边未重建所导致手术失败类别的分布相同(P=0.098)。翻修治疗策略:钢板螺钉再固定5例,钢缆捆绑1例,髋关节置换11例,内固定取出3例,更换髓内钉固定6例,三角重建固定策略21例,另有6例患者由于身体原因未在我院进行后续治疗。结论:对于股骨近端骨折的治疗,近端三角形结构任何一个单边重建失败,均将引起股骨近端结构不稳,导致骨折固定治疗失败。
Objective To explore the effect of invalid reconstruction of proximal triangular structure on clinical failure of proximal femoral fractures treatment.Methods A retrospective study of patients with femoral neck or intertrochanteric fractures postoperative failures from January 2013 to December 2018 was performed.Fifty-three patients including 26 males and 27 females(31 intertrochanteric fractures and 22 femoral neck fractures)met the inclusion criteria.The mean age of included patients was 55.13 years(range,18-94 years).Fixation strategies included plate screws(18 cases),cannulated screws(13 cases)and intramedullary nails(22 cases).Medial side,the lateral side and the upper side were defined according to the law of mechanics based on the proximal femoral structure and statistical analysis of the failure factors of reconstruction of different sides were performed based on the imaging data of postoperative failure cases.Results Nineteen of 53 patients were without medial side reconstruction,4 cases without lateral side reconstruction,21 cases without upper side reconstruction,2 cases without medial or lateral side reconstruction and 7 cases were without medial or upper side reconstruction.Sixteen cases experienced loss of reduction,and 23 cases suffered from nonunion;excessive movement of fixation occurred in 12 cases,and fixation breakage occurred in 2 cases.Indicated by statistical analysis,it was invalid reconstruction of different sides that lead to surgical failure(P=0.098).Revision strategy:5 cases were treated with plate-screw fixation,1 with steel cable binding,11 with hip replacement,3 with internal fixation removal,6 with intramedullary nail replacement,21 with triangular reconstruction fixation,and 6 cases had not been followed up successfully.Conclusion Invalid reconstruction of any side of the proximal triangular structure will cause instability of the proximal structure which can lead to the failure of fracture fixation during the treatment of proximal femoral fractures.
作者
李建涛
张里程
徐高翔
唐佩福
Li Jiantao;Zhang Licheng;Xu Gaoxiang;Tang Peifu(Department of Orthopaedics,Chinese PLA General Hospital,Beijing 100853,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2020年第14期928-935,共8页
Chinese Journal of Orthopaedics
关键词
髋骨折
治疗失败
生物力学
Hip fractures
Treatment failure
Biomechanics
