【摘要】：目的 回顧性分析股骨轉(zhuǎn)子間骨折術(shù)后發(fā)生骨不連的病例及其相關(guān)的翻修治療,探討分析可能的危險因素,提高對股骨轉(zhuǎn)子間骨折術(shù)后骨不連的認(rèn)識,并為臨床翻修治療骨不連提供合理指導(dǎo)。 方法 回顧搜集浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院骨科2010年01月至2015年02月收治的14例股骨轉(zhuǎn)子間骨折術(shù)后骨不連患者的病史資料和檢查資料,并對翻修術(shù)后患者進(jìn)行隨訪,統(tǒng)計學(xué)分析數(shù)據(jù),匯總制作成圖表。 結(jié)果 我科共收治14例轉(zhuǎn)子間骨折不愈合患者,平均年齡59.3歲；從骨折到翻修平均時間為13.3個月；初次內(nèi)固定選擇包括：髓內(nèi)釘8例、動力髖螺釘2例、鎖定鋼板4例,其中3例初次內(nèi)固定后出現(xiàn)感染；原始骨折按AO分型：A3型7例、A2型2例、A1型5例；初次手術(shù)采用髓內(nèi)固定失敗的8例患者中1例予以加用一塊小鋼板,3例予以全髖置換,4例予以更換為鎖定鋼板；動力髖螺釘治療失敗的2例患者中1例改為髓內(nèi)固定,1例予以全髖關(guān)節(jié)置換術(shù)；鎖定鋼板失敗的4例患者中2例更換為動力髖螺釘,1例僅植骨,1例更換為鎖定鋼板重新固定取髂骨植骨。14例患者術(shù)后隨訪,所有患者骨折均治愈,翻修術(shù)前Harris評分平均為30.0±8.7分,末次隨訪時平均為83.7+7.5分,較術(shù)前明顯提高,差異顯著(P0.05)。 結(jié)論 股骨轉(zhuǎn)子間骨折術(shù)后骨不連與感染,骨折粉碎程度、骨折端血供破壞,骨折端加壓、復(fù)位情況以及初始內(nèi)固定選擇相關(guān),針對不同失敗原因選擇相應(yīng)的翻修措施可以取得良好的臨床效果。
[Abstract]:objective
A retrospective analysis of the cases of bone nonunion after the intertrochanteric fracture of the femur and the related refurbishment treatment is reviewed. The possible risk factors are discussed and analyzed. The understanding of the bone nonunion after the intertrochanteric fracture of the femur is improved, and the rational guidance for the clinical revision and treatment of bone nonunion is provided.
Method
The medical history and examination data of 14 cases of intertrochanteric fracture of femur after the operation of intertrochanteric fracture in the Department of orthopedics, Second Hospital Affiliated to the Medical College of Zhejiang University, from 01 months to 02 months of 2015, from 2010 to 02 months of 2015 were reviewed and collected, and the patients were followed up and the statistical analysis data were collected and made into a chart.
Result
14 cases of intertrochanteric fracture nonunion were treated in our department, with an average age of 59.3 years; the average time from fracture to refurbishment was 13.3 months; primary internal fixation included 8 cases of intramedullary nail, 2 cases of dynamic hip screw and 4 locking plate, among which 3 cases were infected after initial internal fixation; the original fracture was classified as type A3 7, A2 type 2, and 5 cases of A1. 1 of the 8 patients who failed in the initial operation with intramedullary fixation were added to a small plate, 3 were total hip replacement and 4 were replaced with locking plates; 1 of the 2 patients who failed by the dynamic hip screw were changed into intramedullary fixation, 1 were total hip replacement; 2 of the 4 patients who failed to lock the plate were replaced as power. Hip screw, 1 cases of bone graft only, 1 cases of replacement of locking plate and refixed iliac bone graft in.14 patients, all the patients were followed up after operation. All the patients were cured. The average Harris score before the refurbishment was 30 + 8.7 points, and the average was 83.7+7.5 points at the last follow-up. The difference was significantly higher than that before the operation (P0.05).
conclusion
Bone nonunion and infection, fracture degree, blood supply damage at the end of fracture, compression of fracture end, reduction and initial internal fixation are related after intertrochanteric fracture of femur, and good clinical effect can be obtained by selecting corresponding refurbishment measures for different reasons of failure.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前9條

1 蔣電明;楊友剛;;老年髖部骨折手術(shù)風(fēng)險性評估及治療方式的選擇[J];重慶醫(yī)學(xué);2008年10期

2 漆偉;;股骨近端鎖定板治療高齡股骨粗隆骨折15例體會[J];重慶醫(yī)學(xué);2008年19期

3 李云峰;劉百偉;陸堅;俞衛(wèi)忠;王暉;何建新;劉延輝;王以進(jìn);吳永方;;應(yīng)用ALHP固定股骨粗隆間不穩(wěn)定性骨折的生物力學(xué)研究[J];創(chuàng)傷外科雜志;2009年01期

4 唐虎子;張曉陽;;人工股骨頭置換治療老年不穩(wěn)定股骨轉(zhuǎn)子間骨折[J];臨床骨科雜志;2009年05期

5 王振業(yè);溫琦;;股骨轉(zhuǎn)子間骨折治療的進(jìn)展[J];中國藥物與臨床;2012年03期

6 章f，

本文編號：2170281