微创内固定系统治疗复杂股骨转子部骨折的初步报告

The less invasive stabilization system in treatment of complex proximal femoral fractures

目的探讨微创内固定系统(LISS)治疗复杂股骨转子部骨折的可行性、手术技术及指征,并总结其近期临床治疗效果。方法自2005年6月～2006年5月,应用LISS治疗复杂股骨转子部骨折12例。骨折采用AO分类法,其中转子间骨折5例：31-A2．2型2例,31-A2．3型2例,31-A3．3型1例；转子下骨折7例：32-A3．1型1例,32-B1．1型3例,32-B2．1型1例,32-B3．1型2例。记录手术时间、术中出血量、术后住院时间,术后观察有无感染、下肢深静脉血栓、心肺疾患、应激性溃疡等并发症。术后1、2、3、6、12个月时常规随访。结果手术时间50～90 min,平均65 min；出血量50～400 mL,平均142 mL,术后住院时间6～15 d,平均9．3 d。无死亡病例。所有患者均未出现切口感染、下肢深静脉血栓、术后心肺疾患、应激性溃疡等并发症。12例均获得3～14个月(平均7．2个月)随访。10例在术后3个月复查骨折时达到临床愈合,1例假体周围骨折术后4个月、1例病理性骨折术后6个月达到临床愈合。所有患者在最后一次随访时均无骨折再移位、髋内翻畸形、内固定切出、内固定失败及股骨头坏死。结论微创反向使用股骨LISS从生物力学和解剖结构上都能满足股骨近端骨折内固定要求,并具有创伤小、操作简便、固定可靠、安全性高、并发症少的特点,尤其适用于老年人合并内科疾病、骨质疏松较重的转子间骨折及复杂的股骨近端骨折。熟练掌握间接复位技术,正确放置A孔导针,避免过早负重是手术成功的关键。

Objective To discuss the feasibility, indications, surgical techniques, and outcome conceming the application of less invasive stabilization system （LISS） for complex proximal femoral fractures. Methods We treated 12 complex proximal femoral fractures using femoral LISS reversely from June 2005 to May 2006. They were five complex intertrochanteric fractures and seven subtrochanteric ones. By AO classification, two were type 31-A2.2, two type 31-A2.3, one type 31-A3.3, one type 32-A3. 1, three type 32-B1. 1, one type 32-B2. 1, and two type 32-B3. 1. The patients were treated with closed or indirect reduction and fixation with percutaueous LISS plate reversely. Results There were no major postoperative complications in this study. The mean operation time was 65 minutes （range, 50 to 90 minutes）, the mean intra-operative blood loss was 142 milliliters （range, 50 to 400 milliliters）, and the mean postoperative hospital stay was 9.3 days （range, 6 to 15 days）. All patients had a clinical follow-up; the mean follow-up time was 7.2 months （range, 3 to 14 months）. Ten cases healed clinically three months postoperatively, one periprosthetic fracture healed four months and one pathological fracture healed six months after operation. At the final radiographic follow-up, no collapse, varus deformity, cutting-out, hardware failure, or avascular necrosis was found. Conclusions Femoral LISS used reversely can provide secure fixation for proximal femoral fractures biomechanically and anatomically. It is also easy and safe. It is particularly suitable for old patients with intertrochanteric fractures complicated with disorders of internal organs and severe osteoporosis or patients with complex proximal femoral fractures. It is important to be skillful in indirect reduction and positioning of guide wire into hole A, and to avoid immediate weight-beating postoperatively.