MIPPO结合NCB万向锁定板在老年股骨转子间骨折的运用

Minimally invasive percutaneous plate osteosynthesis combined with Non-Contact-Bridging for the treatment of elderly femoral intertrochanteric fracture

目的探讨运用MIPPO(微侵入钢板插入技术)结合NCB万向锁定板在老年股骨转子间骨折的治疗效果。方法运用MIPPO结合NCB万向锁定板对2013年7月至2015年10月收治的35例老年转子间骨折患者进行治疗,男21例,女14例;右髖16例,左髖19例;年龄为68~92岁,平均年龄83.5岁,Evans分型Ⅰ型2例,Ⅱ型5例,Ⅲ型11例,Ⅳ型10例,Ⅴ型7例。术前对患者均行骨盆正蛙位X光片和CT扫描,记录患者的手术时间、术中出血量、并发症情况、骨折愈合时间及末次随访时髖关节Harris评分等,初步分析该方法治疗老年股骨转子间骨折疗效和经验。结果本组患者手术时间平均为50.2 min(40~65 min),术中出血量平均为180 m L(150~230 m L)。35例患者术后均获得平均15.6个月(12~39个月)随访,1例出现术后内固定松脱后再行半髖置换治疗,34例术后均获得骨性愈合,平均愈合时间7.8个月(6~9个月)。术后末次随访时34例患者髖关节Harris评分平均为84.5分(75~90分)。结论 MIPPO结合NCB万向锁定板对于老年股骨转子间骨折治疗是有效、可靠的治疗方法,特别对于骨质疏松型股骨转子间骨折,微创MIPPO结合NCB万向锁定板可以达到更好的复位和早期稳定,是对老年股骨转子间骨折微创治疗方法的有益探索。

Objective To explore the effects of minimally invasive percutaneous plate osteosynthesis(MIPPO)combined with Non-Contact-Bridging(NCB)universal in the treatment of femoral intertrochan-teric fractures in the elderly.Methods A total of 35 patients with femoral intertrochanteric fractures were included in this paper from Jul.2013 to Oct.2015.Of them,there were 21 males and 14 females;16 right hips,19 left hips;aged 68 to 92 years with a mean age of 83.5 years,Evans typeⅠtype in 2 cases,typeⅡin 5 cases,typeⅢin 11 cases,typeⅣin 10 and typeⅤin 7.A ll patients underwent X-ray pelvic radiographs and CT scans before operation.The operative time,intraoperative blood loss,complications,fracture healing time,Harris hip score at the final follow-up were recorded,and the results were analyzed.Results The average operation time was 50.2 minutes(40~65),and the average intraoperative blood loss was 180 ml(150~230).A ll the 35 patients were followed up for an average of 15.6 months(12 to 39 months)after surgery.One patient developed postoperative internal fixation and then hemiarthroplasty.A nother 34 patients received bony union after operation.The average healing time was 7.8 months(6 to 9).A t the final follow-up,34 patients had an average Harris hip score of 84.5 points(75 to 90 points).Conclusion Surgical procedure of MIPPO combined with NCB is an effective and reliable treatment for intertrochanteric fractures in the elderly,especially for osteoporotic intertro-chanteric fractures,which can achieve better reset and early stability.