中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2015年
1期
45-49
,共5页
独行业%周正明%殷小军%顾家烨%徐耀增
獨行業%週正明%慇小軍%顧傢燁%徐耀增
독행업%주정명%은소군%고가엽%서요증
髋骨折%骨折,不愈合%股骨近端髓内钉
髖骨摺%骨摺,不愈閤%股骨近耑髓內釘
관골절%골절,불유합%고골근단수내정
Hip fractures%Fracture,ununited%Proximal femoral nails
目的 评价股骨转子间骨折内固定失效后行股骨近端防旋髓内钉(PFNA)内固定加自体髂骨植骨术的疗效. 方法 选择2007年1月-2012年6月采用切开复位PFNA内固定加自体髂骨植骨术治疗初始内固定失效的股骨转子间骨折患者21例,其中男9例,女12例;年龄27 ～ 76岁,平均54岁.Ⅰ期失效的内固定包括动力髋螺钉(DHS)7例,股骨近端锁定钢板(LPFP)8例,Gamma钉2例,股骨近端髓内钉(PFN)2例,国产重建钉2例. 结果 手术时间平均150 min(100～240 min),出血量平均800 ml(400 ～2 000 ml),术中无严重并发症.随访6～ 66个月,平均26个月,所有患者均获得骨愈合,平均愈合时间4个月(3～8个月).Harris髋关节功能评分:术前为36 ～ 48分[(42.1±3.2)分],末次随访为62 ～ 94分[(87.2±3.8)分](P＜0.05).X线片测量颈干角平均130°时(110°～ 142°),未发现髋关节退行性改变及股骨头无菌性坏死表现.结论 对于活动能力强、股骨近端残留骨量多、髋关节无严重损害的股骨转子间骨折内固定失效患者,PFNA内固定加自体髂骨植骨术可获得满意疗效.
目的 評價股骨轉子間骨摺內固定失效後行股骨近耑防鏇髓內釘(PFNA)內固定加自體髂骨植骨術的療效. 方法 選擇2007年1月-2012年6月採用切開複位PFNA內固定加自體髂骨植骨術治療初始內固定失效的股骨轉子間骨摺患者21例,其中男9例,女12例;年齡27 ～ 76歲,平均54歲.Ⅰ期失效的內固定包括動力髖螺釘(DHS)7例,股骨近耑鎖定鋼闆(LPFP)8例,Gamma釘2例,股骨近耑髓內釘(PFN)2例,國產重建釘2例. 結果 手術時間平均150 min(100～240 min),齣血量平均800 ml(400 ～2 000 ml),術中無嚴重併髮癥.隨訪6～ 66箇月,平均26箇月,所有患者均穫得骨愈閤,平均愈閤時間4箇月(3～8箇月).Harris髖關節功能評分:術前為36 ～ 48分[(42.1±3.2)分],末次隨訪為62 ～ 94分[(87.2±3.8)分](P＜0.05).X線片測量頸榦角平均130°時(110°～ 142°),未髮現髖關節退行性改變及股骨頭無菌性壞死錶現.結論 對于活動能力彊、股骨近耑殘留骨量多、髖關節無嚴重損害的股骨轉子間骨摺內固定失效患者,PFNA內固定加自體髂骨植骨術可穫得滿意療效.
목적 평개고골전자간골절내고정실효후행고골근단방선수내정(PFNA)내고정가자체가골식골술적료효. 방법 선택2007년1월-2012년6월채용절개복위PFNA내고정가자체가골식골술치료초시내고정실효적고골전자간골절환자21례,기중남9례,녀12례;년령27 ～ 76세,평균54세.Ⅰ기실효적내고정포괄동력관라정(DHS)7례,고골근단쇄정강판(LPFP)8례,Gamma정2례,고골근단수내정(PFN)2례,국산중건정2례. 결과 수술시간평균150 min(100～240 min),출혈량평균800 ml(400 ～2 000 ml),술중무엄중병발증.수방6～ 66개월,평균26개월,소유환자균획득골유합,평균유합시간4개월(3～8개월).Harris관관절공능평분:술전위36 ～ 48분[(42.1±3.2)분],말차수방위62 ～ 94분[(87.2±3.8)분](P＜0.05).X선편측량경간각평균130°시(110°～ 142°),미발현관관절퇴행성개변급고골두무균성배사표현.결론 대우활동능력강、고골근단잔류골량다、관관절무엄중손해적고골전자간골절내고정실효환자,PFNA내고정가자체가골식골술가획득만의료효.
Objective To evaluate the effect of proximal femoral nail antirotation (PFNA) with autogenous bone grafting for salvage of failed internal fixation of intertrochanteric hip fracture.Methods Between January 2007 and June 2012,21 cases of intertrochanteric fractures who had failed internal fixation initially were treated with revision open reduction and PFNA internal fixation and autogenous bone grafting.There were 9 men and 12 women with the mean age of 54 years (range,27-76 years).In the initially failed internal fixation,dynamic hip screw (DHS) was used in 7 cases,locking proximal femoral plate (LPFP) in 8 cases,Gamma nail in 2 cases,proximal femoral nail (PFN) in 2 cases and home-made reconstruction nail in 2 cases.Results Mean operation time was 150 minutes (range,100-240 minutes) and mean blood loss was 800 ml (range,400-2,000 ml).There were no serious complications during operation.Mean follow-up was 26 months (range,6-66 months).Bone healing was achieved at mean 4 months (range,3-8 months) in all cases.Harris hip score was (42.1 ±3.2) points (range,36-48 points) before operation and (87.2 ± 3.8) points (range,62-94 points) at the final follow-up,with significant improvement in hip function (P ＜ 0.05).At the final follow-up,no avascular necrosis of the femoral head or hip degeneration occurred and mean neck-shaft angle was 130° (range,110°-142°).Conclusions Once the fracture patients with strong ability of action,massive proximal femoral residuals,and non-serious hip injury,revision PFNA internal fixation with autogenous bone grafting is effective.Complete preoperative evaluation and attention to specific technical details may improve success rate and reduce complications.
