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中华老年骨科与康复电子杂志 ›› 2022, Vol. 08 ›› Issue (06) : 330 -337. doi: 10.3877/cma.j.issn.2096-0263.2022.06.003

所属专题: 经典病例

髋部骨折

股骨转子周围骨折内固定术后骨不连的分析和治疗:55例病例总结
蔡乐益1, 郑文浩1, 项光恒1, 陈华1, 陈龙1,()   
  1. 1. 325000 温州医科大学附属第二医院创伤骨科
  • 收稿日期:2022-09-14 出版日期:2022-12-05
  • 通信作者: 陈龙

Management of internal fixation-related nonunion of peritrochanteric fractures of the femur: a summary of 55 cases

Leyi Cai1, Wenhao Zheng1, Guangheng Xiang1, Hua Chen1, Long Chen1,()   

  1. 1. Department of Traumatology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
  • Received:2022-09-14 Published:2022-12-05
  • Corresponding author: Long Chen
引用本文:

蔡乐益, 郑文浩, 项光恒, 陈华, 陈龙. 股骨转子周围骨折内固定术后骨不连的分析和治疗:55例病例总结[J]. 中华老年骨科与康复电子杂志, 2022, 08(06): 330-337.

Leyi Cai, Wenhao Zheng, Guangheng Xiang, Hua Chen, Long Chen. Management of internal fixation-related nonunion of peritrochanteric fractures of the femur: a summary of 55 cases[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2022, 08(06): 330-337.

目的

对股骨转子周围骨折内固定术后骨不连进行分析、归类并提出治疗策略。

方法

回顾性收集本院2005年至2020年间55例股骨转子周围内固定术后出现骨不连的患者,女性20例,男性35例,平均年龄(44±16)岁。分析并根据不同的骨不连原因,采用不同的治疗策略,对所有患者进行临床和影像学随访,记录临床资料和功能数据。

结果

根据骨不连的不同原因,采用相对应的手术策略,患者均顺利完成手术,手术时间(122±22)min;出血量(823±209)ml,其中52名患者进行了术中输血,平均输血量为(424±199)ml。除了关节置换的患者,其余骨折均获得愈合。术前髋关节Harris评分为(40.4±6.1)分,术后末次随访的髋关节Harris评分为(88.5±2.4)分;术前VAS评分为(7.2±1.0)分,术后末次随访的VAS评分为(1.1±0.8)分;术前SF-36评分为(42.0±7.2)分,术后末次随访的SF-36评分为(84.8±3.7)分,差异均有统计学意义(均P<0.05)。

结论

针对股骨转子周围骨折内固定术后骨不连,需正确分析其原因和制定治疗策略,最终可有效减少患者髋关节疼痛,恢复髋关节功能。

Objective

To analyze, categorize and propose treatment strategies for nonunion occurring after internal fixation of peritrochanteric fractures of the femur.

Methods

The author collected cases with nonunion after peritrochanteric internal fixation between 2005 and 2020. 20 women and 35 men, with an average age of (44±16) years, were treated with corresponding strategies according to the cause of the bone nonunion. All patients were followed up clinically.

Results

According to the cause of the bone nonunion, corresponding surgical strategies were adopted. The operation time was (122±22) min, and the amount of blood loss was (823±209) ml. 52 patients received intraoperative blood transfusions, and the average amount of blood transfusion was 423.6 ml. All fractures healed except in patients with joint replacement. The preoperative Harris score of the hip joint was (40.4±6.1) points, and the final postoperative follow-up Harris score was (88.5±2.4) points; the preoperative VAS score was (7.2±1.0) points; the final postoperative follow-up VAS score was (1.1±0.8) points; The preoperative SF-36 score was (42.0±7.2), and the SF-36 score at the last follow-up after surgery was (84.8±3.7) points, both of which were statistically significant.

Conclusion

For the nonunion related to internal fixation of femoral peritrochanteric fractures, it is necessary to analyze the causes and formulate treatment strategies, which can ultimately effectively reduce the pain of the patient's hip joint and effectively restore the function of the hip joint.

图1 患者纳入研究流程图
图8~15 男性,45岁,右侧转子间骨折,外院行闭合复位PFNA内固定,术后1年骨折未愈合。图8术前X线片;图9~10更换施乐辉长的Intertan髓内钉,外侧小钢板+自体骨植骨;图11~12术后3个月,内固定位置良好,骨折趋于愈合;图13~15术后12个月,骨折愈合
图26~32 男性,83岁,右侧股骨转子骨折内固定术后4个月。图26~27内固定出现螺钉切割;图28~29行内固定取出,生物型人工股骨头置换术;图30术后3个月X线;图31术后6个月X线;图32术后1年X线,位置良好,假体无沉降
图42~51 40岁男性,既往糖尿病20余年,摔倒。图42左侧股骨转子下粉碎性骨折;图43~45切开复位Intertan髓内钉固定,钛缆环扎固定;图46术后2月,骨折端出现异常增生的骨痂,提示感染;图47术后6个月,骨折端及远端皮质出现异常骨膜反应,创口可见窦道,提示内固定相关感染;图48~49术后8、10个月,彻底清创,骨水泥置入髓内钉及股骨表面控制感染;图50拆除内固定,髓腔内扩髓清创,配以外固定支具;图51拆除内固定术后6个月,感染控制,骨折基本愈合
图53~56 女性,80岁,右侧股骨粗隆骨折内固定术后6个月。图53髓内钉断裂;图54行内固定取出,骨水泥型人工股骨头置换术,出现股骨远端螺钉孔骨水泥渗漏;图55术后6个月;图56术后1年
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