中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2008年
12期
1108-1111
,共4页
孙林%毛玉江%吴新宝%王满宜
孫林%毛玉江%吳新寶%王滿宜
손림%모옥강%오신보%왕만의
Hip fractures%Fractures,ununited%Fractures fixation,internal
目的 评价股骨转子问骨折术后内固定失效行再次内固定加自体髂骨植骨术的疗效. 方法回顺性研究2000年1月至2008年3月间收治的股骨转子问骨折术后内固定失效、骨折不愈合病例31例,其中25例接受切开复位重新内固定加自体髂骨植骨术.一期失效的内固定种类包括动力髋螺钉12例,髁钢板3例,角钢板1例,带锁髓内针3例和空心钉6例.根据遗留骨质状况以及骨折类型选择更换的内固定物,包括股骨近端髓内钉12例,动力髁螺钉7例,动力髋螺钉4例和角钢板2例.所有患者均行自体髂骨植骨. 结果随访时间6-84个月,平均24个月.平均手术时间200 min(120～240 rain),平均出血量1500 mL(800～3000 mL).术中和术后无严重并发症发生.骨折愈合24例,愈合率为96.0%(24/25).25例患者术后髋关节Harris评分平均87分(35～100分),优良率为76.0%.随访患者X线片测量颈十角平均120.(110°～140°),无股骨头缺血坏死表现及髋关节退行性改变. 结论对于股骨转子间骨折术后内固定失效的患者,股骨近端只要存在可固定的骨质,患者的髋关节无严重损害,再次内固定加植骨治疗能够获得满意的临床结果.
目的 評價股骨轉子問骨摺術後內固定失效行再次內固定加自體髂骨植骨術的療效. 方法迴順性研究2000年1月至2008年3月間收治的股骨轉子問骨摺術後內固定失效、骨摺不愈閤病例31例,其中25例接受切開複位重新內固定加自體髂骨植骨術.一期失效的內固定種類包括動力髖螺釘12例,髁鋼闆3例,角鋼闆1例,帶鎖髓內針3例和空心釘6例.根據遺留骨質狀況以及骨摺類型選擇更換的內固定物,包括股骨近耑髓內釘12例,動力髁螺釘7例,動力髖螺釘4例和角鋼闆2例.所有患者均行自體髂骨植骨. 結果隨訪時間6-84箇月,平均24箇月.平均手術時間200 min(120～240 rain),平均齣血量1500 mL(800～3000 mL).術中和術後無嚴重併髮癥髮生.骨摺愈閤24例,愈閤率為96.0%(24/25).25例患者術後髖關節Harris評分平均87分(35～100分),優良率為76.0%.隨訪患者X線片測量頸十角平均120.(110°～140°),無股骨頭缺血壞死錶現及髖關節退行性改變. 結論對于股骨轉子間骨摺術後內固定失效的患者,股骨近耑隻要存在可固定的骨質,患者的髖關節無嚴重損害,再次內固定加植骨治療能夠穫得滿意的臨床結果.
목적 평개고골전자문골절술후내고정실효행재차내고정가자체가골식골술적료효. 방법회순성연구2000년1월지2008년3월간수치적고골전자문골절술후내고정실효、골절불유합병례31례,기중25례접수절개복위중신내고정가자체가골식골술.일기실효적내고정충류포괄동력관라정12례,과강판3례,각강판1례,대쇄수내침3례화공심정6례.근거유류골질상황이급골절류형선택경환적내고정물,포괄고골근단수내정12례,동력과라정7례,동력관라정4례화각강판2례.소유환자균행자체가골식골. 결과수방시간6-84개월,평균24개월.평균수술시간200 min(120～240 rain),평균출혈량1500 mL(800～3000 mL).술중화술후무엄중병발증발생.골절유합24례,유합솔위96.0%(24/25).25례환자술후관관절Harris평분평균87분(35～100분),우량솔위76.0%.수방환자X선편측량경십각평균120.(110°～140°),무고골두결혈배사표현급관관절퇴행성개변. 결론대우고골전자간골절술후내고정실효적환자,고골근단지요존재가고정적골질,환자적관관절무엄중손해,재차내고정가식골치료능구획득만의적림상결과.
Objective To evaluate the secondary internal fixation plus bone grafting for salvage of failed internal fixation for intertrochanteric hip fractures. Methods Between January 2001 and March 2008, 25 patients with intertrochanteric fractures who had suffered from failed initial internal fixation were treated with secondary open reduction and internal fixation and bone auto grafting. They were 15 men and 10 women, with a mean age of 50 (17 to 72) years. The mean interval between the initial operation and the revision was 12 (4 to 27) months. The failure of original internal implants involved the dynamic hip screw (DHS) in 12 patients, the dynamic condylar screw (DCS) in 3, the angular blade plate (ABP) in 1, the cephalomedullary nail in 3 and the cannulated screw in 6. The replacement of internal implants included PFN in 12 eases, DCS in 7, DHS in 4 and ABP (95°) in 2. Results The mean follow-up was 24 (6 to 84) months. The revisions were uneventful. Of the 25 nonunions, 24 healed (96.0%). The postoperative mean hip rating (Harris score) for the hip joint was 87(35 to 100) points. The X-ray films at the last follow-up revealed the coLlodiaphyseal angle averaged 120° ( 110° to 140°). No avascular necrosis of the femoral head or hip degeneration was found. Conclusion In properly selected patients, secondary internal fixation with bone grafting for failed open reduction and internal fixation of intertrochanteric hip fractures can provide a high rate of union and good clinical results with a low rate of complications.
