锁定钢板及缆绳联合治疗老年长段粗隆骨折

Treatment of long unstable femoral intertrochanteric fractures with locking plate and cable rope

目的:探讨锁定钢板和缆绳治疗老年长段粗隆间骨折的临床疗效。方法:自2004年6月至2010年6月治疗26例老年长段粗隆间骨折,男16例,女10例;年龄50～65岁,平均(58.23±4.45)岁。车祸伤22例,其中10例合并其他复合伤;坠落伤4例。Evans分型:I型21(顺转子型),其中Ia型8例,Ib型10例,Ic型2例,Id型1例;Hrd型(逆转子型)5例。26例中均采用锁定钢板及缆绳固定治疗,髋关节功能根据Harris评分。结果:26例均获得随访,时间9～18个月,平均15个月。手术顺利,术后7～14d下地无负重功能锻炼,6周逐渐负重功能锻炼,12周后逐渐完全负重。髋关节功能Harris评分,疼痛(39.79±6.54)分,功能(31.08±9.45)分,畸形及活动(3.85±0.46)分,总分(77.31±13.97)分;结果优10例,良13例,可3例。结论:锁定钢板及缆绳适合治疗老年长段涉及粗隆Evans分型的各种类型骨折,尤其是骨质疏松患者取得较好临床效果。

Objective： To investigate clinical effect of long unstable femoral intertrochanteric fractures with locking plate and cable rope. Methods： From June 2004 to June 2010, twenty-six elderly patients with long unstable femoral intertrochanteric fractures were treated locking plate and cable rope fixation, included 16 males and 10 females with an average age of （58.23± 4.45 ） years ranging from 50 to 65 years. There were 22 cases for traffic accident, 10 of them for traffic accident with other injury; 4 cases for falling injury. According to Evans classification, 21 cases were in type I, among them 8 in type Ia, 10 in type Ib,2 in type Ic, 1 in type Id; the other 5 cases were type Hrd. Hip function scores were recorded to evaluate the treatment outcomes by Harris hip function score system. Results： Twenty-six cases were followed-up for 9 to 18 months （means 15 months ）. The operations were successful. All the patients received functional training for walking without weight loading from 7 to 14 days after operation, and walking gradually in weight loading from 6 weeks after operation, gradually fully weight loading from 12 weeks. The Harris hip function score were 77.31 ±13.97, involving pain 39.79±6.54, function 31.08±9.45, deformity and activity 3.85±0.46. The clinical results were excellent in 10 cases, good in 13, fair in 3. Conclusion： Locking plate and cable rope is suiteable for the treatment of senile long femoral intertrochanteric fractures of every Evans type, especially benefit for osteoporosis patients.