股骨转子周围骨折钉板系统内固定失败的翻修

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摘要目的：探讨股骨转子周围骨折术后钉板内固定系统失效行再次翻修手术的方法及疗效。方法：回顾性分析2007年1月至2013年1月温州医科大学附属第二医院收治的28例股骨转子区骨折术后内固定失效、骨折不愈合病例的临床资料，并对患者进行随访。结果：28例患者平均手术时间为170 min（110～280 min），平均出血量为1 100 mL（700～2 600 mL）。术后无严重并发症发生。21例行再次内固定，骨折愈合20例，愈合率为95.2%（20/21）。术后髋部疼痛明显改善，仅3例有轻度疼痛，1例中度疼痛。术后行走能力：23例正常行走，4例需扶单拐行走，1例不能行走。随访髋关节Harris评分为83分（33～100分），其中优16例，良5例，中6例，差1例，优良率为75.0%。X线片测量颈干角平均125°（100°～140°）。结论：股骨转子周围骨折钉板系统内固定失效后治疗方法通常包括假体置换和再次内固定。对于年轻患者和部分活动能力较强、骨质好和髋关节状态良好的老年患者，采用再次内同定加植骨治疗，选用内固定种类主要根据原固定方式及骨质缺损情况，股骨近端髓内钉（PFN）、动力髁螺钉（DCS）、微创动力髋钢板（DLK）均是较好的选择；而对活动要求较低以及骨质不佳、头颈部骨质有缺损吸收或髋关节有损害的老年患者采取关节置换，能够获得满意的临床结果。

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	林依怀1
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关键词 ：髋关节；骨折, 不愈合；骨折固定术, 内

Abstract：Objective: To explore the methods and efficacy of salvage of failed nail-plate system internal fixation for peritrochanteric hip fractures. Methods: The clinical data of failed intertrochanteric area fracture and nonunion after surgery in 28 cases admitted to the Second Affiliated Hospital of Wenzhou Medical University from January 2007 to January 2013 were retrospectively analyzed. Results: The mean operation duration was 170 min (110-280 min). Follow-up time was 7-79 months (mean 29 months). Healing of internal fixation of fracture was 20 cases, the healing rate being 95.2% (20/21). Postoperative hip pain improved significantly, only 3 cases were mild pain, 1 case moderate pain. Ability to walk after surgery: 23 cases of normal walking, 4 cases needed to help with the cane to walk, 1 case was unable to walk. Postoperative Harris hip average score was 83 points (33-100 points) in 28 cases, of whom excellent was in 16 cases, good in 5 cases, medium in 6 cases and poor in 1, excellent rate being 75.0%. Measurements of neck shaft angle was 125° (100°-140°) in X-ray film. Conclusion: Treatment method usually includes the replacement of the prosthesis and re-fixation, after intertrochanteric fracture fixation screw-plate system is failure. The same internal fixation plus graft treatment is used again for young patients and some ability, good bone and good hip status in elderly patients. Selection of kinds of internal fixation bases on types of fixation and bone defects. PFN, DCS and DLK are better choices. Joint replacement is adopted for lower activities and poor bone, head and neck bone defect absorption or hip damage in elderly patients, which are able to obtain satisfactory clinical results.

Key words： hip joint fractures, ununited fractures fixation, internal

收稿日期: 2014-04-28

作者简介: 林依怀（1986-），男，浙江温州人，住院医师。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2015/V45/I2/134

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