股骨转子周围骨折内固定术后骨不连的分析和治疗:55例病例总结

Management of internal fixation-related nonunion of peritrochanteric fractures of the femur:a summary of 55 cases

目的对股骨转子周围骨折内固定术后骨不连进行分析、归类并提出治疗策略。方法回顾性收集本院2005年至2020年间55例股骨转子周围内固定术后出现骨不连的患者,女性20例,男性35例,平均年龄(44±16)岁。分析并根据不同的骨不连原因,采用不同的治疗策略,对所有患者进行临床和影像学随访,记录临床资料和功能数据。结果根据骨不连的不同原因,采用相对应的手术策略,患者均顺利完成手术,手术时间(122±22)min;出血量(823±209)ml,其中52名患者进行了术中输血,平均输血量为(424±199)ml。除了关节置换的患者,其余骨折均获得愈合。术前髋关节Harris评分为(40.4±6.1)分,术后末次随访的髋关节Harris评分为(88.5±2.4)分;术前VAS评分为(7.2±1.0)分,术后末次随访的VAS评分为(1.1±0.8)分;术前SF-36评分为(42.0±7.2)分,术后末次随访的SF-36评分为(84.8±3.7)分,差异均有统计学意义(均P<0.05)。结论针对股骨转子周围骨折内固定术后骨不连,需正确分析其原因和制定治疗策略,最终可有效减少患者髋关节疼痛,恢复髋关节功能。

Objective To analyze,categorize and propose treatment strategies for nonunion occurring after internal fixation of peritrochanteric fractures of the femur.Methods The author collected cases with nonunion after peritrochanteric internal fixation between 2005 and 2020.20 women and 35 men,with an average age of(44±16)years,were treated with corresponding strategies according to the cause of the bone nonunion.All patients were followed up clinically.Results According to the cause of the bone nonunion,corresponding surgical strategies were adopted.The operation time was(122±22)min,and the amount of blood loss was(823±209)ml.52 patients received intraoperative blood transfusions,and the average amount of blood transfusion was 423.6 ml.All fractures healed except in patients with joint replacement.The preoperative Harris score of the hip joint was(40.4±6.1)points,and the final postoperative follow-up Harris score was(88.5±2.4)points;the preoperative VAS score was(7.2±1.0)points;the final postoperative follow-up VAS score was(1.1±0.8)points;The preoperative SF-36 score was(42.0±7.2),and the SF-36 score at the last follow-up after surgery was(84.8±3.7)points,both of which were statistically significant.Conclusion For the nonunion related to internal fixation of femoral peritrochanteric fractures,it is necessary to analyze the causes and formulate treatment strategies,which can ultimately effectively reduce the pain of the patient's hip joint and effectively restore the function of the hip joint.