锁定加压钢板治疗高龄患者股骨粗隆间骨折

Application of Locking Compression Plates for the Treatment of Intertrochanteric Hip Fractures in the Elderly

目的探讨锁定加压钢板(locking compression plate,LCP)治疗高龄患者股骨粗隆间骨折的应用方法。方法自2008年2月～2010年3月,我院采用股骨近端锁定加压钢板治疗高龄老年股骨粗隆间骨折48例。其中男性20例,女性28例,平均年龄72.4(61～89)岁;按Evans-Jensen骨折分型[1]:Ⅰ型10例,Ⅱ型12例,Ⅲ型10例,Ⅳ型14例,Ⅴ型2例。结果经术后平均11.5(6～18)月随访,骨折愈合平均时间6.3(4～7)个月。畸形愈合1例,因髋关节功能良好,未予以特殊处理;发生髋内翻2例,予以手术切开复位,DHS内固定,15个月后愈合良好;肢体短缩2例,短缩均在2 cm内,不影响下肢功能;内固定松动、失效2例,予再次手术后切开复位,DHS内固定,术后8个月时复查见骨折线模糊,内置物位置良好。术后6月,参照Harris髋关节功能评分标准评价术后髋关节功能,其中优26例,良17例,差5例,髋关节功能恢复优良率达89.6%。结论股骨近端锁定钢板具有操作简单,固定牢固,并发症少,早期行功能活动锻炼等优点,是治疗老年股骨转子间骨折的良好内固定方法。

Objective To discuss the treatment of intertrochanteric hip fracture with the proximal femur locking compression plates.Methods 48 patients（20 male and 28 female） with intertrochanteric hip fractures were treated with LCPs from February 2008 to March 2010.The average age of patients was 72.4 years old（from 61 to 89 years old）.According to Evans-Jensen classification,10 cases were classified as Ⅰ,12 cases asⅡ,10 cases as Ⅲ,14 cases as Ⅳand 2 cases asⅤ.Results All the cases were followed up for 11.5 months（from 6 to 15 months）.The mean osseous cicatrization duration was 6.3（4~7） months.One patient suffered from the malunion,but got no special handling because of the normal hip joint function.In the two cases of coxa vara,the surgery was undergone for open replacement and DHS fixation.These two patients healed good 15 months later.The body contraction within 2cm was found in 2 cases and got no treatment because it hardly affected the patients＇ lower limb function.Fixation loosening and failure was occurred in two cases,and got cured by reoperation.According to the Harris criterion,there were excellent in 26 cases,good in 17 cases and poor in 5 cases.The excellent and good rate was 89.6%.Conclusions It is recommended of the proximal femur locking compression plates with advantages of simple operation and firm fixation for intertrochanteric hip fractures in the elderly.It can offer the elderly patients early exercises and reduce the incidence of complications.