股骨近端锁定板治疗不稳定型股骨粗隆间骨折失败的原因分析
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摘要
股骨粗隆间骨折是指股骨基底部至小粗隆水平以上部位的骨折,属于关节囊外骨折,约占髋部骨折的50%,多发于老年人,女性多于男性,随着全球人口老龄化速度的加快,股骨粗隆间骨折的发生率成逐年升高的趋势。而在老年病患中,常伴有骨质疏松和内科疾病,保守治疗往往效果较差,并发症及死亡率较高。因此,目前国内外均主张早期手术治疗,以尽早功能练习,恢复患髋功能,减少畸形愈合的发生率,从而减少全身并发症的出现。在手术治疗方法中,采取股骨近端锁定板进行固定是比较常用的内固定方式,但随着股骨近端锁定板的广泛应用,也出现了一些失败的病例。本文对采用股骨近端锁定板治疗不稳定型股骨粗隆间骨折手术失败的原因做如下综述。
Femoral intertrochanteric fracture,a kind of extracapsular fracture,refers to fracture from the basement of femur to the part above tuberosity,accounting for about 50% of hip fractures. It generally happens among the elderly,with females outnumbering males.With the increasing pace of aging around the globe,the ccurance rate of femoral intertrochanteric fracture increases annually.Among elderly patients,it is often accompanied by osteoporosis and other diseases.The effect of conservative treatment is poor,with high incidence of complications and mortality.Therefore,early surgical treatment is advised both home and abroad to exercise and recover hip functions,lowering the occurrence of malunion and systematic complications.In surgical treatment plans,proximal femoral locking plating fixation is an often adopted internal fixation method.There were also a few failure cases in the application of proximal femoral locking plate.The article reviewed the reasons for failures in the surgical treatment of unstable femoral intertrochanteric fracture by proximal femoral locking plate.
Femoral intertrochanteric fracture,a kind of extracapsular fracture,refers to fracture from the basement of femur to the part above tuberosity,accounting for about 50% of hip fractures. It generally happens among the elderly,with females outnumbering males.With the increasing pace of aging around the globe,the ccurance rate of femoral intertrochanteric fracture increases annually.Among elderly patients,it is often accompanied by osteoporosis and other diseases.The effect of conservative treatment is poor,with high incidence of complications and mortality.Therefore,early surgical treatment is advised both home and abroad to exercise and recover hip functions,lowering the occurrence of malunion and systematic complications.In surgical treatment plans,proximal femoral locking plating fixation is an often adopted internal fixation method.There were also a few failure cases in the application of proximal femoral locking plate.The article reviewed the reasons for failures in the surgical treatment of unstable femoral intertrochanteric fracture by proximal femoral locking plate.
引文
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[10]张静,李志锐,唐佩福.老年粗隆间骨折的手术治疗进展[J].中华老年骨科与康复电子杂志,2016,2(4):250-253.
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[12]黄永栋,赵辉,张.PFNA与解剖型锁定钢板内固定治疗老年股骨粗隆间骨折的疗效比较[J].中国骨与关节损伤杂志,2015,30(4):402-404.
[13]李在全,董红让,叶东平,等.锁定钢板治疗股骨粗隆间粉碎性骨折内固定失败原因分析及对策[J].中国煤炭工业医学杂志,2013,16(1):18-19.
[14]Kyle RF,Gustilo RB,Premer RF.Analysis of six hundreds and twenty-two intertrochanteric hip fractures:a retrospective and prospective study[J].J Bone Joint Surg(Am),1979,61(2):216-221.
[15]黄永栋,赵辉,张.PFNA与解剖型锁定钢板内固定治疗老年股骨粗隆间骨折的疗效比较[J].中国骨与关节损伤杂志,2015,30(4):402-404.
[16]周胜虎,甄平,李旭升,等.生物型FHR与PFNA治疗高龄股骨粗隆间骨折疗效观察[J].中国矫形外科杂志,2017,25(6):487-491.
[17]崔志刚.锁定型钢板固定联合药物治疗股骨粗隆骨质疏松性骨折的临床分析[J].医药论坛杂志,2017,38(9):116-117
[18]殷渠东,顾三军,孙振中,等.植骨在预防四肢骨折术后骨不连的价值[J].中国骨与关节损伤杂志,2013,28(5):431-433.
[19]Akan K,Cift H,Ozkan K,et al.Effect of osteoporosis on clinical outcomes in intertrochanteric hip fractures treated with a proximal femoral nail[J].J Int Med Res,2011,39(3):857-865.
[20]Chen Kai,Yang Chang-wei,Wang Qiu-gen.Applied principles and cautions of locking compression plate[J].Journal of Clinical Rehabilitative Tissue Engineering Research,2008,12(17):3398-3400.
[21]徐烁,党小伍,贺西京.股骨近端钢板内固定治疗股骨粗隆间骨折手术并发症分析[J].中国骨与关节损伤杂志,2014,29(2):135-137.
[22]潘芳,韩冷,谭荣莉.骨科康复一体化模式对老年股骨粗隆间骨折术后功能恢复影响的研究[J].中国疗养医学,2018,27(2):122-124.
[23]罗敬.早期序贯康复护理应用于老年股骨粗隆间骨折的效果研究[J].中国疗养医学,2016,25(8):828-830.
[2]Gunadham U,Jampa J,Suntornsup S,et al.The outcome in early cases of treatment of subtrochanteric fractures with proximal femur locking compression plate[J].Malays Orthop J,2014,8(2):22-28.
[3]Zha GC,Chen ZL,Qi XB,et al.Treatment of pertrochanteric fractures with a proxima femur locking compression plate[J].Injury,2011,42(11):1249-1299.
[4]王虎,尹芸生.老年股骨粗隆间骨折患者死亡的相关危险因素[J].中国临床研究,2016,29(3):420-423.
[5]熊蠡茗,胡益强,邵增务,等.股骨近端锁定板固定治疗老年不稳定型股骨转子间骨折[J].中华创伤骨科杂志,2014,19(2):115-120.
[6]杨俊龙,刘志祥,赖震,等.股骨近端解剖锁定钢板治疗老年股骨粗隆间骨折的临床分析[J].中国实用医药,2016,11(19):35-37.
[7]Zhu QL,Yan MH,Zhao LL,et al.Analysis of treatment of osteoporotic intertrochanteric fracture of femur with the locking compression plate(LCP)[J].Zhongguo Gu Shang,2011,24(5):378-381.
[8]张明,李百通,姚猛.股骨转子间粉碎性骨折中小转子处理的临床治疗进展[J].创伤外科杂志,2016,19(4):315-318.
[9]王波,吴鹏,刘长松,等.股骨粗隆间骨折手术并发症分析[J].实用骨科杂志,2016,22(12):1124-1127.
[10]张静,李志锐,唐佩福.老年粗隆间骨折的手术治疗进展[J].中华老年骨科与康复电子杂志,2016,2(4):250-253.
[11]蔡迎峰,陈胜,张维.股骨小粗隆缺损的生物力学评价及临床意义[J].骨与关节损伤杂志,2001,16(3):178-179.
[12]黄永栋,赵辉,张.PFNA与解剖型锁定钢板内固定治疗老年股骨粗隆间骨折的疗效比较[J].中国骨与关节损伤杂志,2015,30(4):402-404.
[13]李在全,董红让,叶东平,等.锁定钢板治疗股骨粗隆间粉碎性骨折内固定失败原因分析及对策[J].中国煤炭工业医学杂志,2013,16(1):18-19.
[14]Kyle RF,Gustilo RB,Premer RF.Analysis of six hundreds and twenty-two intertrochanteric hip fractures:a retrospective and prospective study[J].J Bone Joint Surg(Am),1979,61(2):216-221.
[15]黄永栋,赵辉,张.PFNA与解剖型锁定钢板内固定治疗老年股骨粗隆间骨折的疗效比较[J].中国骨与关节损伤杂志,2015,30(4):402-404.
[16]周胜虎,甄平,李旭升,等.生物型FHR与PFNA治疗高龄股骨粗隆间骨折疗效观察[J].中国矫形外科杂志,2017,25(6):487-491.
[17]崔志刚.锁定型钢板固定联合药物治疗股骨粗隆骨质疏松性骨折的临床分析[J].医药论坛杂志,2017,38(9):116-117
[18]殷渠东,顾三军,孙振中,等.植骨在预防四肢骨折术后骨不连的价值[J].中国骨与关节损伤杂志,2013,28(5):431-433.
[19]Akan K,Cift H,Ozkan K,et al.Effect of osteoporosis on clinical outcomes in intertrochanteric hip fractures treated with a proximal femoral nail[J].J Int Med Res,2011,39(3):857-865.
[20]Chen Kai,Yang Chang-wei,Wang Qiu-gen.Applied principles and cautions of locking compression plate[J].Journal of Clinical Rehabilitative Tissue Engineering Research,2008,12(17):3398-3400.
[21]徐烁,党小伍,贺西京.股骨近端钢板内固定治疗股骨粗隆间骨折手术并发症分析[J].中国骨与关节损伤杂志,2014,29(2):135-137.
[22]潘芳,韩冷,谭荣莉.骨科康复一体化模式对老年股骨粗隆间骨折术后功能恢复影响的研究[J].中国疗养医学,2018,27(2):122-124.
[23]罗敬.早期序贯康复护理应用于老年股骨粗隆间骨折的效果研究[J].中国疗养医学,2016,25(8):828-830.