经皮微创技术在股骨钢板内固定中的应用

Minimally Invasive Plate Fixation in Combined Intertrochanteric and Subtrochanteric Fractures of the Femur

目的 :探讨经皮微创技术在股骨钢板内固定手术中的临床价值。方法 :6 8例股骨近段复杂粉碎骨折的病人 ,采用经皮微创的钢板内固定术 36例 ;传统开放复位的钢板内固定术治疗 32例。两例术后短期死亡 ,余 6 6例获随诊 ,平均时间为 15个月。对手术切口长度、术中出血量、手术时间、术后起床活动时间、手术并发症、术后X线显示复位内固定的质量和骨愈合结果、临床功能进行评估。结果 :经皮微创技术钢板内固定的手术创伤明显小于传统开放复位的钢板内固定术 (P <0 .0 0 1) ;微创法组的术后起床活动的时间较开放复位法组的要早 (P <0 .0 0 1) ;微创法组的骨愈合比开放复位组的早 ,而开放复位法组的骨延迟愈合率明显高于微创法组 (P <0 .0 5 ) ;两组手术并发症和临床骨愈合后的功能评定差异无显著 (P >0 .0 5 )。结论 :微创技术能减少传统开放复位钢板内固定术治疗股骨近段粉碎骨折的手术创伤 ,对提高钢板内固定手术在骨折治疗中的疗效 ,促进骨折早期愈合有临床意义。

Objective:To assess the clinical value of minimally invasive plate fixation technique for combined intertrochanteric and subtrochanteric fractures of the femur. Methods: Sixty eight patients with combined intertrochanteric and subtrochanteric fractures of the femur were treated with minimally invasive percutaneous plating (36 cases) or conventional open reduction plate fixation (32 cases).Sixty six patients were followed up in the mean time of 15 months. The intra operative injury including incision length,blood loss,operation time,and postoperative condition including bed rest time,operative complication,radiographic and clinical results were analysed. Result: There were a less intra operative injury and a earlier movement in the minimally invasive plate fixation group ( P <0.001). There was a earlier bone healing in the minimally invasive plate fixation group( P <0 05). There was no significant difference of the final clinical functions between two groups( P> 0.05). Conclusion: A percutaneous minimally invasive plating technique makes the surgical trauma less than the traditional open method and has significant advantages for blood loss,soft tissue healing and early bone union.