摘要
目的探讨钛缆环扎钢板联合加长股骨近端防旋髓内钉(PFNA)治疗不稳定股骨转子间骨折内固定术后再发骨折的临床疗效。方法采用回顾性病例系列研究分析2010年1月—2018年1月陆军军医大学西南医院收治的17例不稳定股骨转子间骨折内固定术后再发Vancouver B型股骨骨折患者的临床资料,其中男7例,女10例;年龄65~94岁[(75.7±13.2)岁]。采用钛缆捆绑钢板联合加长PFNA进行翻修手术治疗,同时行抗骨质疏松治疗。术后3 d、3,6和12个月分别摄髋关节正、侧位X线片,记录患者术后骨折愈合情况、围术期并发症、术前及术后6,12个月髋关节功能Harris评分、视觉模拟评分(VAS)、身体健康评分(PCS)、精神健康评分(MCS)和健康状况调查量表(SF-36)。结果患者均获随访12~18个月[(15.3±2.8)个月]。患者均获骨性愈合,愈合时间3~6个月[(3.6±1.1)个月]。1例出现腰骶部压疮,经换药后痊愈;2例出现坠积性肺炎,给予抗生素雾化吸入、吸痰等对症处理后完全缓解。术后6,12个月髋关节Harris评分为(76.5±5.2)分和(85.5±5.7)分,较术前(32.8±5.1)分明显提高(P<0.05)。术后6,12个月VAS为(3.3±0.5)分和(1.2±0.7)分,明显低于术前(8.5±0.7)分(P<0.05)。术后6,12个月PCS分别为(44.2±4.9)分和(56.9±5.8)分,较术前(29.3±4.7)分显著提高(P<0.05)。术后6,12个月MCS分别为(47.9±6.8)分和(58.4±7.9)分,较术前(39.7±5.9)分显著提高(P<0.05)。术后6,12个月SF-36评分为(493.9±85.7)和(603.4±76.8)分,明显高于术前(415.9±88.2)分(P<0.05)。结论钛缆捆绑钢板联合加长PFNA治疗不稳定股骨转子间骨折术后再发骨折可提供骨折端的稳定性,促进骨折愈合,减少并发症,减轻疼痛,提高患者生活质量。
Objective To investigate the clinical effect of titanium cable binding plate combined with lengthened proximal femoral nail antirotation(PFNA)for fixation of recurrent fracture after treatment of unstable intertrochanteric fractures.Methods A retrospective case series study was conducted for analyzing the clinical data of 17 patients with recurrent fracture of unstable intertrochanteric fractures admitted to Southwest Hospital of Army Medical University from January 2010 to January 2018.There were 7 males and 10 females,aged from 65 to 94 years[(75.7±13.2)years].The patients were treated using titanium cable binding plate combined with PFNA.Anti-osteoporosis therapy was applied as well.X-ray images were performed at postoperative 3 days,3,6 and 12 months.The healing and complications of the patients were recorded.The Harris hip score,visual analogue score(VAS),physical health score(PCS),mental health score(MCS)and 36item short form health survey questionnaire(SF-36)were evaluated before operation and at postoperative 6 and 12 months.Results All patients were followed-up for 12-18 months[(15.3±2.8)months].Bone healing was achieved in all patients,and the postoperative bone healing time was 3-6 months[(3.6±1.1)months].One patient developed lumbosacral pressure sores and recovered after dressing change.Two patients developed drooping pneumonia,which was completely relieved after symptomatic treatment including nebulized inhalation of antibiotics and sputum aspiration.At postoperative 6 and 12 months,Harris hip score was(76.5±5.2)points and(85.5±5.7)points,significantly higher than(32.8±5.1)points before operation(P<0.05);VAS was(3.3±0.5)points and(1.2±0.7)points,significantly lower than(8.5±0.7)points before operation(P<0.05);PCS was(44.2±4.9)points and(56.9±5.8)points,significantly higher than(29.3±4.7)points before operation(P<0.05);MCS was(47.9±6.8)points and(58.4±7.9)points,significantly higher than(39.7±5.9)points before operation(P<0.05);SF-36 was(493.9±85.7)points and(603.4±76.8)points,sig
作者
汤勇
陈灿
孙东
谭玖林
谢肇
罗飞
许建中
Tang Yong;Chen Can;Sun Dong;Tan Julin;Xie Zhao;Luo Fei;Xu Jianzhong(Department of Orthopedics,Southuest Hospital,Army Medical University,Chongqing 400038,China;Department of Orthopedics,72nd Hospital of Army,Huzhou 313000,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2020年第8期692-697,共6页
Chinese Journal of Trauma
基金
军队后勤科研重大项目(AWS17J004)。
关键词
髋骨折
骨折内固定术
髓内
老年人
股骨近端防旋髓内钉
Hip fractures
Fracture fixation,intramedullary
Aged
Proximal femoral nail antirotation
