CAJ | 학술논문

目的总结微创内固定系统(LISS)接骨板倒置治疗股骨转子部骨折的疗效,并探讨其适应证. 方法回顾性分析2005年6月至2011年6月期间采用LISS接骨板倒置治疗的72例股骨转子部骨折患者资料,男33例,女39例；平均年龄为73.4岁(45 ～87岁).记录本组患者的手术时间、术中出血量、围手术期并发症及末次随访时内固定相关并发症的发生情况等.术后随访摄X线片评估骨折愈合情况,采用髋关节Harris评分标准评定患者术后关节功能. 结果本组患者手术时间平均为141.4 min,术中出血量平均为138.1 mL.围手术期并发症:下肢深静脉血栓形成3例,肺炎1例,消化道出血1例,多脏器功能衰竭致患者死亡1例,术后谵妄1例.65例(90.3％)患者术后获平均22.1个月(18 ～46个月)随访.骨折愈合时间平均为4.2个月(3～8个月).末次随访时髋关节Harris评分平均为73.7分(20 ～100分),其中优8例,良19例,可25例,差13例,优良率为41.5％.末次随访时内固定相关并发症的发生率为15.4％ (10/65),包括螺钉断裂6例,骨折不愈合1例,钢板断裂1例,螺钉松动1例,骨折畸形愈合1例. 结论 LISS接骨板倒置治疗股骨转子部骨折的并发症发生率较高,不宜作为常规方法,其适应证为AO分型31A2.2型以上的复杂骨折、髓腔过小或前弓过大者、病理性骨折、假体周围骨折及多发伤需控制创伤者.
목적 총결미창내고정계통(LISS)접골판도치치료고골전자부골절적료효,병탐토기괄응증. 방법 회고성분석2005년6월지2011년6월기간채용LISS접골판도치치료적72례고골전자부골절환자자료,남33례,녀39례；평균년령위73.4세(45 ～87세).기록본조환자적수술시간、술중출혈량、위수술기병발증급말차수방시내고정상관병발증적발생정황등.술후수방섭X선편평고골절유합정황,채용관관절Harris평분표준평정환자술후관절공능. 결과 본조환자수술시간평균위141.4 min,술중출혈량평균위138.1 mL.위수술기병발증:하지심정맥혈전형성3례,폐염1례,소화도출혈1례,다장기공능쇠갈치환자사망1례,술후섬망1례.65례(90.3％)환자술후획평균22.1개월(18 ～46개월)수방.골절유합시간평균위4.2개월(3～8개월).말차수방시관관절Harris평분평균위73.7분(20 ～100분),기중우8례,량19례,가25례,차13례,우량솔위41.5％.말차수방시내고정상관병발증적발생솔위15.4％ (10/65),포괄라정단렬6례,골절불유합1례,강판단렬1례,라정송동1례,골절기형유합1례. 결론 LISS접골판도치치료고골전자부골절적병발증발생솔교고,불의작위상규방법,기괄응증위AO분형31A2.2형이상적복잡골절、수강과소혹전궁과대자、병이성골절、가체주위골절급다발상수공제창상자.
Objective To discuss outcomes of and indications for treatment of femoral trochanteric fractures with reversed less invasive stabilization system (LISS).Methods A retrospective study was performed for 72 consecutive patients with femoral trochanteric fracture who had been treated with reversed LISS at our institution between June 2005 and June 2011.They were 33 men and 39 women,with a mean age of 73.4 years (range,45 to 87 years).The operation time,intraoperative blood loss,intra-hospital complications and internal fixation-related complications at the last follow-up were analyzed.The fracture union was assessed by follow-up radiographs and hip functional recovery by Harris hip scoring.Results The operation time averaged 141.4 minutes and the intraoperative blood loss averaged 138.1 mL.The intra-hospital complications included deep venous thrombosis in 3 cases,pneumonia in one,gastrointestinal bleeding in one,postoperative delirium in one,and a death resulting from multiple organ failure.Sixty-five patients (90.3％) obtained a mean follow-up of 22.1 months (range,18 to 46 months).The fracture union was achieved after an average of 4.2 months (range,3 to 8 months).The mean Harris score at the last follow-up was 73.7 points (range,20 to 100 points).Eight patients were excellent,19 good,25 fair and 13 poor,giving an excellent to good rate of 41.5％.The internal fixation-related complications at the last follow-up were observed in 10 out of the 65 patients (15.4％),including 6 cases of screw breakage,one of nonunion,one of plate breakage,one of screw loosening and one of malunion.Conclusions Reversed LISS should not be a routine treatment for femoral trochanteric fractures because of its high rate of complications.We recommend its indications include fractures more complex than AO type 31A2.2,those with a narrow medullary canal,those with a severely bowed or deformed femur,pathologic and periprosthetic ones and those with multiple traumas and a priority of immediate trauma control.