股骨近端锁定钢板置入内固定修复老年股骨转子间陈旧性骨折

Proximal femoral locking plate fixation for obsolete intertrochanteric fracture in old patients

背景:临床上老年股骨转子间陈旧性骨折病例较少见,治疗方式上钢板固定系统、髓内固定系统、关节置换各有优缺点,暂无统一的意见。目的:观察股骨近端解剖锁定钢板置入内固定治疗老年陈旧性转子间骨折的疗效。方法:回顾性分析2009年1月至2012年12月湖南常德市第一人民医院骨二科收治的老年陈旧性转子间骨折患者16例,年龄58-72岁,男10例,女6例,平均年龄67.3岁,12例患者为摔伤,4例患者为交通意外受伤。内固定至受伤时间为4-25周,平均6.7周,施行切开复位股骨近端解剖锁定钢板内固定+植骨,术中使用C型臂X射线机检查复位内固定情况。结果与结论:所有患者均复位内固定满意,伤口均一期愈合,如期拆线。随访6-32个月,按髋关节Harris评分11例为优,4例为良,1例为中,优良率为94%。所有患者均骨性愈合,内固定无松动断裂。提示对于老年陈旧性转子间骨折患者,进行良好的置入前准备后,施行股骨近端解剖锁定钢板置入内固定配合植骨,为一种稳妥有效的修复方法,内固定后髋关节功能恢复较好。

BACKGROUND：The cases of obsolete intertrochanteric fractures in the elderly are rare, and therapeutic manners are diverse such as plate fixation, intramedulary fixation and joint replacement. These methods have their own advantages and disadvantages. OBJECTIVE：To observe therapeutic effects of proximal femoral locking plate for obsolete intertrochanteric fracture in old patients. METHODS： This study retrospectively analyzed 16 patients with obsolete intertrochanteric fracture at the age of 58-72 years, who were recruited from Second Department of Orthopedics, Changde Municipal First People’s Hospital in China from January 2009 to December 2012. There were 10 males and 6 females with an average age of 67.3 years old. Among 16 cases, there were 12 cases caused by fal injury and 4 cases caused by traffic accident. The patients underwent open reduction ＋ anatomic locking plate fixation at proximal femur in 4-25 weeks after injury, with an average of 6.7 weeks. C-arm X-ray machine was used for checking the reduction and fixation in al operations. RESULTS AND CONCLUSION： Reduction and fixation of al cases were satisfactory. Wounds were healed primarily and stitches were taken out on schedule. They were folowed-up for 6-32 months. There were excelent in 11 cases, good in 4 cases and average in 1 case according to Harris score system with an excelent and good rate of 94%. Bone healing was observed in al patients, and no fixation loosening was found. These results indicated that using proximal femoral locking plate combined with bone graft in old patients with obsolete＆nbsp;intertrochanteric fracture is an effective treatment. It can get good functional recovery of hip joint.