CAJ | 학술논문

目的评估微创经皮钢板固定术(minimally invasive percutaneous plate osteosynthesis, MIPPO)结合动力髁螺钉(dynamic condylar screw,DCS)治疗青壮年股骨转子下不稳定骨折的临床价值.方法 2001年1月至2006年1月,手术治疗25例股骨转子下不稳定骨折患者,男18例,女7例;年龄25～40岁,平均35岁;左侧12例,右侧13例;车祸伤20例,坠落伤5例.骨折按照Seinsheimer分型:ⅢA型15例,ⅢB型4例,Ⅳ型6例,均为闭合性骨折.手术均采用MIPPO结合DCS进行治疗.术后采用Harris评分对患髋关节功能进行评价.结果所有病例均获得随访,随访时间9～24个月,平均16个月.骨折均全部骨性愈合,愈合时间3～4个月,平均3.5个月.无一例发生钢板断裂、螺钉松动退出及切割、骨折延迟愈合、再骨折、髋内翻畸形、肢体短缩等并发症.采用Harris评分法对患髋功能进行评价,优14例,良8例,可3例,优良率为92%.结论运用MIPPO技术结合BO原理置入DCS可以有效减小手术创伤及减少手术并发症,有利于骨折愈合和髋关节功能恢复,是一种有效治疗股骨转子下不稳定骨折的方法.
목적 평고미창경피강판고정술(minimally invasive percutaneous plate osteosynthesis, MIPPO)결합동력과라정(dynamic condylar screw,DCS)치료청장년고골전자하불은정골절적림상개치.방법 2001년1월지2006년1월,수술치료25례고골전자하불은정골절환자,남18례,녀7례;년령25～40세,평균35세;좌측12례,우측13례;차화상20례,추락상5례.골절안조Seinsheimer분형:ⅢA형15례,ⅢB형4례,Ⅳ형6례,균위폐합성골절.수술균채용MIPPO결합DCS진행치료.술후채용Harris평분대환관관절공능진행평개.결과 소유병례균획득수방,수방시간9～24개월,평균16개월.골절균전부골성유합,유합시간3～4개월,평균3.5개월.무일례발생강판단렬、라정송동퇴출급절할、골절연지유합、재골절、관내번기형、지체단축등병발증.채용Harris평분법대환관공능진행평개,우14례,량8례,가3례,우량솔위92%.결론 운용MIPPO기술결합BO원리치입DCS가이유효감소수술창상급감소수술병발증,유리우골절유합화관관절공능회복,시일충유효치료고골전자하불은정골절적방법.
Objective To evaluate the technique, indications and results of minimally invasive per-cutaneous plate osteosynthesis (MIPPO) with dynamic condylar screw (DCS) for the treatment of young adults unstable comminuted subtrochanteric fracture. Methods From January 2001 to January 2006, 25 patients with unstable subtrechanteric fracture were treated. There were 18 males and 7 females, with the average age of 35 years (ranged from 25 to 40 years). 20 cases suffered traffic accident injuries, and 5 cases suffered falling down injuries. According to Seinsheimer classification, 15 cases fracture were ⅢA classification, 4 cases fracture were ⅢB classification, 6 cases were ⅣV classification. All of patients were closed fracture, and underwent MIPPO with DCS. The hip joint function was evaluated according to Harris's scale after surgeries. Results All patients were followed up from 9 to 24 months, with the average of 16 months. All subtrochanteric fractures were healed and the healing time was 3--4 months, with the average of 3.5 months. No patients suffered from the complications of plate fracture, screw loosening or cutting out, delayed healing, re-fracture, hip varus deformity, and limb shortening. According to Harris's scale, there were 14 eases excellent, 8 cases were good, 3 cases were fair on the hip joint function, the excellent and good rate was 92%. Conclusion M1PPO with DCS is the credible method for the treatment of young adults unstable comminut-ed subtrochanteric fracture, which can reduce operation complications, and benefit for fracture heal and hip function recovery.