摘要
目的探讨股骨近端解剖锁定钢板加自体髂骨植骨固定治疗股骨转子间骨折内固定失败的临床疗效。方法回顾性分析2014年1月至2017年3月期间西安交通大学医学院附属红会医院创伤骨科收治的29例股骨转子间骨折内固定失败患者资料。男17例,女12例;年龄为35~83岁,平均68.7岁。初次内固定方式:动力髋螺钉固定12例,股骨近端锁定钢板固定13例,髓内钉固定4例。内固定失败原因:头切割8例,骨折不愈合10例,钢板或螺钉断裂6例,髓内钉断裂3例,髋内翻畸形2例。翻修手术均采用股骨近端解剖锁定钢板加自体髂骨植骨固定。记录患者的骨折愈合时间、末次随访时疼痛视觉模拟评分、髋关节Harris评分、健康调查简表(SF-36)评分及并发症发生情况等。结果29例患者翻修术后获12~24个月(平均18个月)随访。所有患者均获骨性愈合,愈合时间平均为4.5个月(3~7个月)。随访期间未出现骨不连、再骨折及内固定失败等并发症。末次随访时患者疼痛视觉模拟评分[(4.6±1.6)分]显著低于术前[(7.1±2.1)分],髋关节Harris评分[(85.2±8.2)分]、SF-36评分[(75.9±15.5)分]显著高于术前[(48.0±12.7)、(48.7±18.8)分],差异均有统计学意义(P<0.05)。末次随访时根据髋关节Harris评分系统评定疗效:优9例,良15例,可4例,差1例,优良率为82.8%。结论对于股骨转子间骨折内固定失败患者,尤其是股骨头颈骨质良好、髋关节状态较好者,股骨近端解剖锁定钢板加自体髂骨植骨固定可获得较满意的临床效果。
Objective To explore the clinical efficacy of proximal femoral anatomical locking plate and autogenous iliac graft for failed primary internal fixation in treatment of femoral intertrochanteric fracture.Methods A retrospective analysis was conducted of the 29 patients with femoral intertrochanteric fracture who had been treated after failed primary internal fixation at Department of Orthopaedics and Trauma,Xi'an Honghui Hospital between January 2014 and March 2017.They were 17 men and 12 women,aged from 35 to 83 years(mean,68.7 years).Their primary internal fixation involved dynamic hip screw in 12 cases,proximal femoral locking plate in 13 cases,and intramedullary nail in 4 cases.The causes for their internal fixation failure included head cutting in 8 cases,fracture nonunion in 10 cases,plate or screw breakage in 6 cases,intramedullary nail breakage in 3 cases,and hip varus in 2 cases.Their revision surgery was performed with anatomical proximal femoral locking plate and autogenous iliac bone graft.Their fracture union time,and visual analogue scale(VAS),hip Harris score,SF-36 health survey scale and complications at the final follow-ups were recorded.Results All the 29 patients were followed up for 12 to 24 months(18 months on average).Bony union was eventually achieved in all the 29 patients after an average time of 4.5 months(from 3 to 7 months).There were no such complications as nonunion,re-fracture or internal fixation failure.The VAS pain score at the final follow-up(4.6±1.6)was significantly lower than that before surgery(7.1±2.1),and the Harris hip score(85.2±8.2)and SF-36 score(75.9±15.5)at the final follow-up were significantly higher than those before surgery(48.0±12.7 and 48.7±18.8)(all P<0.05).According to their hip Harris scores at the final follow-ups,the therapeutic efficacy was rated as excellent in 9 cases,as good in 15 cases and as poor in one,yielding an excellent and good rate of 82.8%.Conclusion For patients with femoral intertrochanteric fracture whose primary internal fixation has
作者
孙健平
薛汉中
孙亮
侯明明
王谦
马腾
任程
刘宏亮
路遥
段宁
李忠
张堃
Sun Jianping;Xue Hanzhong;Sun Liang;Hou Mingming;Wang Qian;Ma Teng;Ren Cheng;Liu Hongliang;Lu Yao;Duan Ning;Li Zhong;Zhang Kun(Department of Orthopaedics and Trauma,Xi'an Honghui Hospital,Xi'an Jiao Tong University Health Science Center,Xi'an 710054,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2020年第9期771-776,共6页
Chinese Journal of Orthopaedic Trauma
基金
陕西省科技厅项目(2015SF116,2015SF110,2016SF340)。
关键词
髋骨折
治疗失败
骨折固定术
内
骨板
植骨
Hip fractures
Treatment failure
Fracture fixation,internal
Bone plates
Bone graft
