CAJ | 학술논문

股骨近端锁定接骨板治疗特殊类型股骨近端骨折
고골근단쇄정접골판치료특수류형고골근단골절
Treatment of special proximal femoral fractures with proximal femur locking plate system

万方数据

中国骨与关节外科中國骨與關節外科 중국골여관절외과
CHINESE BONE AND JOINT SURGERY
2014年 5期 367-369,366 ,共4页

冯旭%禹宝庆%黄建明%施继飞%李承%周建华%顾龙殿%吕涛%敖荣广%胡万坤%丁惠锋%黄利彪

풍욱%우보경%황건명%시계비%리승%주건화%고룡전%려도%오영엄%호만곤%정혜봉%황리표

股骨近端骨折%外侧壁不完整%股骨近端锁定接骨板股骨近耑骨摺%外側壁不完整%股骨近耑鎖定接骨闆
고골근단골절%외측벽불완정%고골근단쇄정접골판
proximal femoral fractures%incomplete lateral wall%proximal femur locking plate system

背景：应用髓内固定系统规范化治疗股骨近端骨折已得到临床上的广泛共识，但是对于某些特殊类型的股骨近端骨折如股骨转子下骨折、股骨近端外侧壁不完整等的治疗仍较困难。 　　目的：探讨股骨近端锁定接骨板（LPFP）治疗特殊类型股骨近端骨折的疗效。 　　方法：2012年5月至2014年5月应用LPFP治疗特殊类型股骨近端骨折22例，其中股骨转子间骨折伴股骨近端外侧壁不完整9例（Evans-Jensen分型：Ⅲ型5例，Ⅴ型4例）；股骨转子下骨折10例（Seinsheimer分型：ⅡA型2例，ⅡB型2例，ⅢB型4例，Ⅴ型2例）；股骨颈骨折伴股骨转子下骨折2例，股骨转子间骨折伴股骨上段骨折1例。所有患者均采用LPFP内固定术，记录手术时间、术中出血量、术后并发症、骨折愈合时间和术后髋关节功能评分。采用Harris评分评估髋关节功能情况。 　　结果：手术时间为65~150 min，平均96 min；出血量为80~750 ml，平均360 ml。22例全部获得随访，随访时间为3~27个月，平均12.8个月。1例患者在术后4个月发生锁钉断裂，2例发生延迟愈合，无一例出现切口感染和深静脉血栓。骨折愈合时间为2~20个月，平均3.2个月。髋关节Harris评分为78~99分，平均86分。 　　结论：LPFP治疗股骨转子下骨折、股骨近端外侧壁不完整等特殊类型股骨近端骨折，具有创伤小、安全性高等特点，是髓内固定治疗股骨近端骨折的有益补充。
배경：응용수내고정계통규범화치료고골근단골절이득도림상상적엄범공식，단시대우모사특수류형적고골근단골절여고골전자하골절、고골근단외측벽불완정등적치료잉교곤난。 　　목적：탐토고골근단쇄정접골판（LPFP）치료특수류형고골근단골절적료효。 　　방법：2012년5월지2014년5월응용LPFP치료특수류형고골근단골절22례，기중고골전자간골절반고골근단외측벽불완정9례（Evans-Jensen분형：Ⅲ형5례，Ⅴ형4례）；고골전자하골절10례（Seinsheimer분형：ⅡA형2례，ⅡB형2례，ⅢB형4례，Ⅴ형2례）；고골경골절반고골전자하골절2례，고골전자간골절반고골상단골절1례。소유환자균채용LPFP내고정술，기록수술시간、술중출혈량、술후병발증、골절유합시간화술후관관절공능평분。채용Harris평분평고관관절공능정황。 　　결과：수술시간위65~150 min，평균96 min；출혈량위80~750 ml，평균360 ml。22례전부획득수방，수방시간위3~27개월，평균12.8개월。1례환자재술후4개월발생쇄정단렬，2례발생연지유합，무일례출현절구감염화심정맥혈전。골절유합시간위2~20개월，평균3.2개월。관관절Harris평분위78~99분，평균86분。 　　결론：LPFP치료고골전자하골절、고골근단외측벽불완정등특수류형고골근단골절，구유창상소、안전성고등특점，시수내고정치료고골근단골절적유익보충。
Background:It is widely recognized to treat proximal femoral fractures with intramedullary internal fixation system in clin-ic. However, there are some difficulties to deal with some special type proximal femoral fractures such as subtrochanteric fractures and intertrochanteric fractures with lateral wall fracture. Objective:To explore the clinical outcome of locking proximal femoral plate (LPFP) in treatment of special proximal femo-ral fractures. Methods:A total of 22 patients with special proximal femoral fractures were treated with LPFP from May 2012 to May 2014. Nine cases suffered from intertrochanteric fractures with lateral wall fracture (Evans-Jensen classification:typeⅢin five and typeⅤin four), 10 with subtrochanteric fractures (typeⅡA in two, typeⅡB in two, typeⅢB in four and typeⅤin two according to Seinsheimer classification), 2 with femoral neck fracture and subtrochanteric fracture, 1 with trochanteric fracture and proximal femoral shaft fracture. Operation time, intraoperative blood loss, postoperative complications, fracture healing time and postoperative hip function score were recorded. Hip joint function was evaluated by Harris scoring system. Results:The operation lasted for 96 min on average (range, 65-150 min). Intraoperative blood loss was 360 ml (range, 80-750 ml). The mean duration of follow-up was 12.8 months in all patients (range, 3-27 months). Proximal locking screw broke up in one patient with type Seinsheimer V fracture 4 months postoperatively. Delayed union happened in two cases. No infection of incisional wound or deep vein thrombosis occurred. The mean healing time of fracture was 3.2 months (range, 2-20 months). The Harris score of hip joint was 86 (range, 78-99). Conclusions: LPFP has advantages of minor invasion, better safety for treatment of special proximal femoral fractures,which is the beneficial supplement to intramedullary fixation.