温州医科大学学报
溫州醫科大學學報
온주의과대학학보
Journal of Wenzhou Medical University
2015年
2期
134-138
,共5页
髋关节%骨折,不愈合%骨折固定术,内
髖關節%骨摺,不愈閤%骨摺固定術,內
관관절%골절,불유합%골절고정술,내
hip joint%fractures,ununited%fractures ifxation,internal
目的:探讨股骨转子周围骨折术后钉板内固定系统失效行再次翻修手术的方法及疗效。方法:回顾性分析2007年1月至2013年1月温州医科大学附属第二医院收治的28例股骨转子区骨折术后内固定失效、骨折不愈合病例的临床资料,并对患者进行随访。结果:28例患者平均手术时间为170 min(110~280 min),平均出血量为1100 mL(700~2600 mL)。术后无严重并发症发生。21例行再次内固定,骨折愈合20例,愈合率为95.2%(20/21)。术后髋部疼痛明显改善,仅3例有轻度疼痛,1例中度疼痛。术后行走能力:23例正常行走,4例需扶单拐行走,1例不能行走。随访髋关节Harris评分为83分(33~100分),其中优16例,良5例,中6例,差1例,优良率为75.0%。X线片测量颈干角平均125°(100°~140°)。结论:股骨转子周围骨折钉板系统内固定失效后治疗方法通常包括假体置换和再次内固定。对于年轻患者和部分活动能力较强、骨质好和髋关节状态良好的老年患者,采用再次内同定加植骨治疗,选用内固定种类主要根据原固定方式及骨质缺损情况,股骨近端髓内钉(PFN)、动力髁螺钉(DCS)、微创动力髋钢板(DLK)均是较好的选择;而对活动要求较低以及骨质不佳、头颈部骨质有缺损吸收或髋关节有损害的老年患者采取关节置换,能够获得满意的临床结果。
目的:探討股骨轉子週圍骨摺術後釘闆內固定繫統失效行再次翻脩手術的方法及療效。方法:迴顧性分析2007年1月至2013年1月溫州醫科大學附屬第二醫院收治的28例股骨轉子區骨摺術後內固定失效、骨摺不愈閤病例的臨床資料,併對患者進行隨訪。結果:28例患者平均手術時間為170 min(110~280 min),平均齣血量為1100 mL(700~2600 mL)。術後無嚴重併髮癥髮生。21例行再次內固定,骨摺愈閤20例,愈閤率為95.2%(20/21)。術後髖部疼痛明顯改善,僅3例有輕度疼痛,1例中度疼痛。術後行走能力:23例正常行走,4例需扶單枴行走,1例不能行走。隨訪髖關節Harris評分為83分(33~100分),其中優16例,良5例,中6例,差1例,優良率為75.0%。X線片測量頸榦角平均125°(100°~140°)。結論:股骨轉子週圍骨摺釘闆繫統內固定失效後治療方法通常包括假體置換和再次內固定。對于年輕患者和部分活動能力較彊、骨質好和髖關節狀態良好的老年患者,採用再次內同定加植骨治療,選用內固定種類主要根據原固定方式及骨質缺損情況,股骨近耑髓內釘(PFN)、動力髁螺釘(DCS)、微創動力髖鋼闆(DLK)均是較好的選擇;而對活動要求較低以及骨質不佳、頭頸部骨質有缺損吸收或髖關節有損害的老年患者採取關節置換,能夠穫得滿意的臨床結果。
목적:탐토고골전자주위골절술후정판내고정계통실효행재차번수수술적방법급료효。방법:회고성분석2007년1월지2013년1월온주의과대학부속제이의원수치적28례고골전자구골절술후내고정실효、골절불유합병례적림상자료,병대환자진행수방。결과:28례환자평균수술시간위170 min(110~280 min),평균출혈량위1100 mL(700~2600 mL)。술후무엄중병발증발생。21례행재차내고정,골절유합20례,유합솔위95.2%(20/21)。술후관부동통명현개선,부3례유경도동통,1례중도동통。술후행주능력:23례정상행주,4례수부단괴행주,1례불능행주。수방관관절Harris평분위83분(33~100분),기중우16례,량5례,중6례,차1례,우량솔위75.0%。X선편측량경간각평균125°(100°~140°)。결론:고골전자주위골절정판계통내고정실효후치료방법통상포괄가체치환화재차내고정。대우년경환자화부분활동능력교강、골질호화관관절상태량호적노년환자,채용재차내동정가식골치료,선용내고정충류주요근거원고정방식급골질결손정황,고골근단수내정(PFN)、동력과라정(DCS)、미창동력관강판(DLK)균시교호적선택;이대활동요구교저이급골질불가、두경부골질유결손흡수혹관관절유손해적노년환자채취관절치환,능구획득만의적림상결과。
Objective:To explore the methods and efifcacy of salvage of failed nail-plate system internal ifxation for peritrochanteric hip fractures. Methods:The clinical data of failed intertrochanteric area fracture and nonunion after surgery in 28 cases admitted to the Second Afifliated Hospital of Wenzhou Medical University from January 2007 to January 2013 were retrospectively analyzed. Results:The mean operation duration was 170 min (110-280 min). Follow-up time was 7-79 months (mean 29 months). Healing of internal ifxation of fracture was 20 cases, the healing rate being 95.2%(20/21). Postoperative hip pain improved signiifcantly, only 3 cases were mild pain, 1 case moderate pain. Ability to walk after surgery:23 cases of normal walking, 4 cases needed to help with the cane to walk, 1 case was unable to walk. Postoperative Harris hip average score was 83 points (33-100 points) in 28 cases, of whom excellent was in 16 cases, good in 5 cases, medium in 6 cases and poor in 1, excellent rate being 75.0%. Measurements of neck shaft angle was 125° (100°-140°) in X-ray iflm. Conclusion:Treatment method usually includes the replacement of the prosthesis and re-ifxation, after intertrochanteric frac-ture ifxation screw-plate system is failure. The same internal ifxation plus graft treatment is used again for young patients and some ability, good bone and good hip status in elderly patients. Selection of kinds of internal ifxation bases on types of ifxation and bone defects. PFN, DCS and DLK are better choices. Joint replacement is adopted for lower activities and poor bone, head and neck bone defect absorption or hip damage in elderly patients, which are able to obtain satisfactory clinical results.