锁定钢板桥接固定治疗股骨粗隆下SeinsheimerⅤ型骨折

Bridging fixation with locking plate for the treatment of subtrochanteric femoral fractures of Seinsheimer type Ⅴ

目的 ：探讨应用锁定钢板桥接固定治疗股骨粗隆下Seinsheimer V型骨折的临床价值。方法 ：2009年3月至2014年9月,采用切开复位、锁定钢板桥接固定治疗18例股骨粗隆下Seinsheimer V型骨折,男16例,女2例;年龄22-67岁,平均41岁。车祸伤12例,高处坠落伤5例,重物砸伤1例;均为闭合性新鲜骨折,伤后至手术时间4-9 d,平均6.2 d。11例使用股骨髁锁定钢板倒置内固定,7例使用股骨近端锁定解剖钢板内固定。结果 ：18例患者手术时间90-155 min,平均110 min;术中出血量350-650 ml,平均425 ml。术中或术后输血共16例,平均输血量300 ml。住院天数为12-18 d,平均14 d。全部病例获得随访,时间8-22个月,平均11.8个月;骨折愈合时间为5-8个月,平均6.6个月。术后未发生感染、内固定失败、髋内翻、下肢外旋畸形、脂肪栓塞等并发症。末次随访Sanders髋关节功能评分平均53.22±6.48,其中优12例,良6例。结论：在坚持生物学固定的前提下,锁定钢板桥接固定治疗股骨粗隆下Seinsheimer V型骨折,具有力学强度高、血供干扰少、并发症少、骨愈合率高、安全可靠的优点,是治疗该类型骨折较为理想的选择。

Objective：To investigate the clinical effect of bridging fixation with locking plate for the Seinsheimer type V subtrochanteric femoral fracture. Methods：From March 2009 to September 2014,18 cases of Seinsheimer type V subtrochanteric femoral fracture were treated by open reduction and bridging fixation with locking plate through proximal and distal approach including 16 males and 2 females with an average age of 41 years old ranging from 22 to 67 years old. Among them,12 cases caused by traffic accident,5 cases by falling,1 case by heavy aboving. All cases were fresh and closed fractures. Time between injury and operation was from 4 to 9 days with an average of 6.2 days. Of them,11 cases were fixed with reverse LISS and the other 7 cases were fixed with anatomical locking plates of proximal femur. Results：The mean time of operation was 110min（ranged from 90 to 155 min）. The mean blood loss during operation was 425 ml（ranged from 350 to 650 ml） and 16 cases got blood transfusion which was meanly 300 ml. The mean hospital time was 14 days（ranged from 12 to 18 days）. The mean duration of followed up was 11.8 months（ranged from 8 to 22 months）. The mean time of bone union was 6.6 months（ranged from 5 to 8 months）. There was not any complication such as infection,implant failure,hip varus,external rotation deformity of low limb or fat embolism. The Sanders hip scores were 53.22±6.48,the result was excellent in 12 cases and good in 6 cases at the last follow up. Conclusion：Under the principle of biological osteosynthesis,treatment of Seinsheimer type V subtrochanteric femoral fracture with bridging locking plate fixation has such advantages as high mechanism,less interference of blood supply,stable fixation and little complication. It is a safe and idea way for the treatment of the Seinsheimer type V subtrochanteric femoral fracture.