股骨髓内钉联合肱骨近端锁定钢板治疗股骨转子下骨折不愈合

Intramedullary Nailing of the Femur Combined with Proximal Humeral Internal Locking System in the Treatment of Non-union of Subtrochanteric Femur Fracture

目的探讨应用股骨髓内钉结合肱骨近端锁定钢板系统(proximal humeral internal locking system,PHILOS)治疗股骨转子下骨不连的临床效果。方法对2020年6月至2023年6月在我院治疗的11例股骨转子下骨不连的病例进行回顾性分析,男6例,女5例,年龄为(57.27±8.19)岁(45~69岁)。按照Seinsheimer划分标准,Ⅱ型骨折2例,Ⅲ型骨折3例,Ⅳ型骨折5例,Ⅴ型骨折1例。初次手术至再次手术的时间为(14.09±2.07)个月(12~18个月)。病人均采用股骨髓内钉与PHILOS手术治疗并辅以自体髂骨植骨。术后采用X线片和CT评价骨折愈合情况,以及依据Harris髋关节评分系统评估病人功能恢复情况。结果随访期间,所有病人的骨折均顺利愈合,骨折愈合时间为(18.64±3.85)周(12~24周),未出现植入物引发的感染或内固定装置失效。根据Harris髋关节功能评分,优7例,良3例,可1例,优良率为90.91%。结论使用股骨髓内钉联合PHILOS治疗股骨转子下骨不连,稳定性较好,可有效避免内固定失效,术后功能恢复良好。

Objective To explore the efficacy of employing femoral intramedullary nailing in conjunction with proximal humeral anatomical plate fixation for the management of non-union in subtrochanteric femur fractures.Methods A retrospective analysis was conducted on 11 cases of femoral intertrochanteric non-union treated in our hospital from June 2020 to June 2023,including 6 males and 5 females,aged(57.27±8.19)years(45-69 years).According to the Seinsheimer classification criteria,there were 2 cases of type Ⅱ fractures,3 cases of type Ⅲ fractures,5 cases of type Ⅳ fractures,and 1 case of type Ⅴ fractures.The time from the first surgery to the second surgery was(14.09±2.07)months(12-18 months).All patients were treated with femoral intramedullary nail and PHILOS surgery,supplemented by autologous iliac bone grafting.The fracture healing was postoperative evaluated using X-rays and CT,and patient functional recovery was assessed using the Harris hip joint scoring system.Results During the follow-up period,all patients'fractures healed smoothly,with a healing time of(18.64±3.85)weeks(12-24 weeks).There were no infections caused by implants or failures of internal fixation devices.According to the Harris hip joint function score,there were 7 cases of excellent effectiveness,3 cases of good effectiveness,and 1 case of fair effectiveness,with an excellent and good rate of 90.91%.Conclusion The use of femoral intramedullary nail combined with PHILOS for the treatment of femoral intertrochanteric non-union has good stability,can effectively avoid internal fixation failure,and has good postoperative functional recovery.