股骨近端锁定钢板治疗老年股骨转子间骨折术后并发症原因分析及防治对策

Risk evaluation and treatment measures of femoral intertrochanteric fracture with proximal femoral locking compression plate in eldly

[目的]总结分析股骨近端锁定钢板治疗老年股骨转子间骨折术后并发症发生的原因,探讨其防治对策。[方法]回顾性分析本院2009年1月~2015年12月采用股骨近端锁定钢板治疗且获得随访的112例老年股骨转子间骨折患者资料,男49例,女63例;年龄60~91岁,平均70.23岁。记录并发症的发生率及末次随访时髋关节Harris功能评分。对术后出现并发症的患者进行分析,探讨其发生的原因及防治的方法。[结果]所有患者获得11~72个月的随访,平均36个月。末次随访Harris评分为32~91分,平均78.86分。112例患者中23例术后出现并发症,发生率为20.54%,其中髋内翻7例,内固定物断裂10例,近端螺钉突出并切割股骨头颈3例,骨折延期愈合3例。10例内固定物断裂者其中9例行二次翻修手术:内固定加植骨4例,人工髋关节置换5例;另1例患者放弃再次翻修手术。[结论]适应证选择不当是导致术后并发症的主要原因,而不稳定骨折、严重骨质疏松及骨折复位不良都将增加失败的发生率;内固定失败者,结合患者年龄、股骨近端骨质情况及髋关节功能行再次内固定加植骨或人工关节置换治疗可获得满意的临床结果。

[Objective] To summarize and analyze the reasons of complications after proximal femoral locking compression plate in the treatment of femoral intertrochanteric fracture in the elderly, and to explore the treatment strategy. [Methods] A retrospective analysis was conducted to summarize the treatment of intertrochanteric fractures in 112 cases with proximal femoral locking compression plate from Jan 2009 to Dec 2015. There were 49 males and 63 females, ranging in age from 60 to 91 years with an average age of 70.23 years. The incidence of failed fixation and the Harris hip scores at the last follow-up were documented. Their postoperative fixation-related complications were analyzed to find out the causes. [Results] The 112 patients obtained a mean follow-up of 36 months（from 11 to 72 months）. The Harris hip scores at the last follow-up averaged 78.86 points（from 32 to 91 points）. Postoperative fixation-related complications occurred in 23 patients（20.54%）,which of 7 patients presented with deformity of hip varus and 3 patients had ‘cut-outs＇ of the proximal screws, with 10 patients having implant failure due to broken proximal screw and（or） locking plate, with 3 patients occurring delayed union of fracture. Revision surgeries were performed in 9 patients, 4 patients underwent reosteosynthesis with implantation of PFNA and5 patients underwent hard-ware removal with secondary implantation of hip prosthesis replacement. [Conclusions] Unsuitable implant selection is an important factor leading to postoperative fixation-related complications.Unstable fracture, serious osteoporosis and unsatisfactory reduction will increase the incidence of complications. In properly selected patients, combined with the patients age, proximal femoral bone and hip function, secondary internal fixation with bone grafting or artificial joint replacement for failed open reduction and internal fixation of intertrochanteric hip fractures can provide a high rate of union and good clinical results with a low rate of complications.