锁定钢板固定治疗股骨粗隆间骨折

一项回顾性研究Locing Compression Plate For Intertrochanteric Fracture: A Retrospective Study【摘要】 目的 讨论锁定钢板固定治疗股骨粗隆间骨折的可行性。 方法 2008年2月-2009年7月我们使用锁定钢板固定治疗股骨粗隆间骨折25例，稳定型骨折8例，不稳定型骨折17例。采用两种不同类型的锁定钢板（PF-LCP、R-LISS）治疗。 结果 术后平均随访11.1月，手术时间为98.6分钟（62-120分钟）。愈合时间5.7±1.1月，2例固定失败，其中一例取出内固定，行关节置换，另一例骨折已愈合，给予直接取出内固定。随访末时患者的社会能力评分和行走能力评分较术前明显降低，有统计学意义，P值分别为0.833和0.833。 结论 锁定钢板同时具有髓内和髓外固定的共同优点，其近端的多钉系统增加了固定的旋转稳定性,可以减少固定失败的几率。更适宜于粉碎性和存在骨质疏松的粗隆间骨折。【关键词】 锁定钢板 粗隆间骨折 回顾性研究【Abstract】 Objective To reseach feasibility of treatment of intertrochanteric fracture using locing pression plate(LCP). Methods From Februery 2008 to july 2009, 25 patients with intertrochanteric fracture were treatmented with two inds of locing pression plate(PF-LCP R-LISS). There include 8 stable fracture and 17 unstable fracture. Results The average follow up was 11.1mouths. The mean operation and union time was 98.6 minutes（Range 62-120 minutes）and 5.7mouths respectively, One failed has taed reoperation of arthroplasty, anther one was removed the interfixation directly. The social function and waling ability was decreased pared to preoperative. P=0.833. Conclusion LCP contained both intramedullary and extramedullary advantage, can increase rotate stability and reduce failure of treatment of intertrochanteric fracture. It is better for minuted and osteaporosis fracture.【ey words】Locing Compression Plate, Intertrochanteric Fracture, Retrospective Study.

目前存在各种各样的治疗股骨粗隆间骨折的方法，大致可以分为髓内髓外两种，髓外包括DHS、DCS和空心螺钉等，髓内的gamma钉、PFN、PFNA等。另外还有其他多种的内固定方式，这些方式都是在以上两类上的改进，其临床的对照比较，与传统的方法并无多少优势。其主要的并发症是髋内翻、割头和股骨干部位的骨折，特别是对于粉碎性骨折和存在骨质疏松的患者。近来有LCP固定治疗粗隆间和粗隆下骨折的报道。下面我们将回顾性研究我们在2008年2月-2009年7月使用锁定钢板固定治疗的25股骨粗隆间骨折。资料和方法

一、 一般资料

从2008年2月-2009年7月我们一共收治53例股骨粗隆间骨折患者，均为单侧。其中25者使用锁定钢板治疗（表一）。25名患者中其中女 4例，男 21例。年龄63.8±17.8岁（27-87岁）。8例为高能量损伤，其中7例为高处坠落，1例为车祸伤，其余均为低能量损伤（走路时摔倒）。其中1例患者合并肱骨外科颈骨折，1例合并眼眶内侧壁骨折，1例合并颧弓骨折。术前分析所有患者的X线片，根据ensen和Michaelsen方法进行分型[1]，Ⅰ、Ⅱ型为稳定性骨折，Ⅲ、Ⅳ和Ⅴ型定义为不稳定。本组中稳定型骨折8例，不稳定型17例。对基础性疾病按照ASA[2]（American Society of Anesthesiologists）分级，分为三级，一级为无基础疾病或处于轻度的病理现实（如：胆囊切除术或已经愈合的骨折）；二级为存在中度严重的疾病（如：高血压、中风、盲、慢性肺心疾病）；三级为存在严重的疾病（如：转移性肿瘤或近发的心肌梗死）。本组16例为一级（无基础疾患），高血压病4例，2例存在脑梗，1例患有早搏和陈旧性肺结核，1例肺气肿，1例患者心功能不全，1例患有糖尿病。无分级为三级的病例。5例患者术前血红蛋白较低，其中3例术前输血治疗。1984年ensen[3]把患者的社会功能分为4级。据此我们认真评估本组病例，大部分为1级（18例），4例2级，3例3级。大部分患者在伤前可以在外力辅助或不辅助下活动，按照Palmer[4]行走功能评分（如表1），大部分获得了9分，6例8分，1例7分，1例6分，1例5分。

二、 方法三、 结果四、讨论

五、 结论

我们认为锁定钢板同时具有髓内和髓外固定的共同优点，其生物力学固定，不容易引起应力集中，减少术后钢板断裂几率；其近端的多钉系统增加了固定的旋转稳定性,更适宜于粉碎性和存在骨质疏松的粗隆间骨折。老年人群轻微的创伤即可导致各种生活质量下降，但积极的治疗仍能降低这种趋势。我们这个研究的不足是，这不适一项随机对照研究，所以下一步的研究应该是锁定钢板随机与DHS/髓内系统对照研究，比较这三种固定的有缺点。目前尚缺少对锁定钢板固定治疗股骨粗隆间骨折的生物力学研究，有待以后完善。

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