钢板内固定治疗脊髓灰质炎后遗症患者股骨干骨折的疗效分析

Clinical Analysis of Effect of Internal Fixation with Plates for Fracture of Femoral Shaft of Patients with Sequelae of Poliomyelitis

目的分析钢板内固定治疗脊髓灰质炎后遗症患者股骨干骨折的疗效。方法回顾性分析2000年6月～2007年6月采用钢板内固定治疗15例脊髓灰质炎后遗症股骨干骨折。骨折按照AO/OTA分类:3.2A型5例,3.2B型9例,3.2C型1例。采用加压钢板治疗5例(A组),锁定加压钢板10例(B组)。随访骨折愈合情况、功能康复情况。所有患者测量了骨密度。结果 13例骨折一期愈合;2例发生内固定松动,均发生于A组,其中1例经二次手术骨折愈合,1例经制动后骨折畸形愈合。平均随访时间23.5个月,骨折平均愈合时间4.5个月。A组的失败率高于B组,P<0.05。疗效参考Mayo KA自定义的功能评定法:优9例,良3例,可2例,差1例。本组患者患肢股骨颈骨密度平均(-2.76±0.25)SD。结论脊髓灰质炎后遗症患者股骨多伴有一定程度的骨质疏松,锁定钢板对疏松骨骼把持力更牢,治疗脊髓灰质炎后遗症患者股骨干骨折疗效满意。

Objective To analyze the outcomes of internal fixation with plates for fracture of femoral shaft of patients with sequelae of poliomyelitis.Methods The analysis was made on 15 cases of poliomyelitis patients who had fractures of femoral shaft and were treated by internal fixation with plates from Jun 2000 to Jun 2007.The patients were average 40.2 years old.According to AO/OTA classification, the fractures were classified as 3.2A in 5eases, 3.2B in 9 cases, 3.2C in 1 ease. All patients were treated by the internal fixation with plates, 5 cases with limited contact dynamic compression plate （LC-DCP）, 10 eases with locking compression plate （LCP）.All cases were measured BMD. All the patients were followed up postoperatively.Results At follow-up of 15 to 63 months 13 cases achieved solid osseous unions, through average 4.5 months postoperatively,2 ease in this study suffered from screws loosening;the fracture of 1 of 2 eases was healed after operation;the fracture of the another ease was healed after immobilization. The patients fixed with LCP had higher union rate than fixed with LC-DCP. BMD of all cases were lower than（-2.76±0.25）SD.The results were excellent in 9 cases, good in 3 cases and fair in 2 cases, bad in lease reference to Mayo KA method.Conclusion Femurs of patients with sequelae of poliomyelitis have some degree osteoporosis.Locking compression plate has angel stability, and is a safe and effective for fractures of femoral shaft of patients with sequelae of poliomyelitis.