改良股骨近端锁定板内固定治疗老年特殊类型股骨粗隆间骨折的疗效观察

Curative effect of modified proximal femoral locking plate in treatment of intertrochanteric fractures of elderly

目的探讨采用改良股骨近端锁定板内固定治疗老年特殊类型股骨粗隆间骨折的临床疗效。方法回顾分析自2009-11—2015-12采用改良股骨近端锁定板内固定治疗的20例老年特殊类型股骨粗隆间骨折,并比较患者术前及术后7 d血流变学指标水平,分析患者术中指标及术后愈合情况。结果手术时间80~120(90.00±9.86)min,术中出血量400~800(480.00±20.37)ml。骨折均一期愈合。术后6个月疗效根据髋关节功能Harris评分标准评定:优12例,良6例,可2例,优良率90%。术后7 d患者的全血比粘度、血浆比粘度、血沉、红细胞电泳和红细胞压积等血流变学指标水平较术前显著下降,差异有统计学意义(P<0.05)。结论特殊类型股骨粗隆间骨折(大粗隆顶骨折、梨状窝粉碎骨折、严重粉碎的外侧壁骨折、冠状面骨折)采用改良股骨近端锁定板内固定能更好形成内在支撑,符合生物力学特性,安全可行。

Objective To explore the effect of modified proximal femoral locking plate in the treatment of intertrochanteric fractures of the elderly. Methods Twenty old patients with intertrochanteric fractures treated with modified proximal femoral locking plates between November 2009 and December 2015 were retrospectively analyzed. All patients were followed up for 6-12 months. The blood hemorheology indicators before and 7 days after operation were detected and compared. Statistical analysis of patients with intraoperative and postoperative indicators of healing was performed. The Harris score standard of hip joint function was used to evaluate the postoperative curative effect. Results The operation time was 80-120 （90.00±9.86） min, the amount of bleeding was 400-800 （480.00±20.37）ml, the fracture was healed. According to the Harris score of hip function, the results were excellent in 12 cases, good 6 cases, and fair 2 cases, the excellent and good rate was 90%. The whole blood viscosity, plasma viscosity, erythrocyte sedimentation, erythrocyte electrophoresis and hematocrit blood rheology index levels 7 days after operation were significantly lower than those before operation （P 〈0.05 or P 〈0.01）. Conclusion Intertrochanteric fractures of the femur are combined with greater trochanter fracture, comminuted fractures of the piriform fossa, serious lateral comminuted fractures of the lateral wall, coronal fracture. The modified proximal femoral locking plate can better form the internal support, which is in line with biomechanical properties, safe and feasible.