解剖型锁定钢板治疗老年不稳定股骨转子间骨折的经验与教训——附80例临床病例报道-骨外科学专业论文.docxVIP

PAGE PAGE 10 解剖型锁定钢板治疗老年不稳定股骨转子间骨折的经验与教训 ——附 80 例临床病例报道 中文摘要 目的 探讨分析解剖型锁定钢板治疗老年不稳定股骨转子间骨折中的经验与教训。 方法 回顾性分析 2011 年 1 月-2014 年 5 月我院采用解剖型锁定钢板加辅助固定（拉 力螺钉或钢丝环扎）治疗老年不稳定股骨转子间骨折的 36 例患者，对严重骨质疏松 患者(18 例)，均使用药物抗骨质疏松治疗，对其中 11 例患者采取股骨头颈钉道内填 充打压混合植骨处理。选取同期单纯使用锁定钢板治疗的 44 例患者为对照组。 结果 80 例患者均获随访，随访时间不少于 1 年，前 3 个月每月复诊至少 1 次。两组 患者在年龄、性别比等基线资料、术后螺钉松动发生率、慢性并发症、术后 6 个月功 能评分方面比较 P0.05，差异无统计学意义；在手术时间和术中出血量上对照组较 辅助固定组手术时间短、术中出血少，P﹤0.05，差异有统计学意义。从术后即刻与 术后 3 个月随访的影像学对比来看，股骨颈的长度和颈干角的丢失在辅助固定组较对 照组少，两者比较 P﹤0.05，差异有统计学意义，术后 3 个月功能评分两组比较 P﹤ 0.05，差异有统计学意义。对照组出现 4 例坠积性肺炎，辅助固定组 3 例，两组各出 现 1 例臀部压疮和深静脉血栓，经治疗后均痊愈。实验组出现 1 例股骨头颈内螺钉松 动，对照组出现 9 例，其中 1 例内固定钢板断裂、髋内翻，后期予人工股骨头置换术 后取得良好疗效。 结论 1、老年不稳定股骨转子间骨折内侧皮质的修复重建符合结构与力学，有利于 骨折愈合，减少断钉、断板。2、对严重骨质疏松患者，通过对股骨头颈钉道内填充 打压混合植骨，辅以抗骨质疏松治疗，能有效增加其对螺钉的把持力。3、老年不稳 定股骨转子间骨折，术后应遵循早锻炼、晚下地负重原则，有利于减少内固定失效的 发生。 关键词 解剖型锁定钢板，股骨转子间骨折，骨质疏松，经验与教训 Treatment of elderly patients with unstable between the trochanter fracture by anatomic locking plate: The experience and lesson during between the trochanter fracture ——Attached to the 80 clinical cases reported Abstract The objective of this master thesis is to get some experience and lessons for the treatment of elderly patients with unstable Between the trochanter fracture by the analysis of anatomic locking plate. The main method is retrospective analysis of using anatomical locking plate fixation (lag screws or steel wire cerclage) plus auxiliary between January 2011 and May 2014 in our hospital. These samples include 36 patients with senile unstable intertrochanteric fractures. For patients with severe osteoporosis (18 cases), anti osteoporosis drug treatment was applied. 11 of these patients were treated by taking the femoral head and neck nail tract filling pressure of mixed planting bone. 44 cases were selected using a simple locking plate in the treatment of patients for comparison. Total 80 patients were followed up. The follow-up time is not less than 6 months, and 3 months before the monthly the patients were visited at le