股骨转子间骨折术后骨不连危险因素分析及相关翻修治疗
发布时间：2018-08-07 14:13
【摘要】：目的 回顾性分析股骨转子间骨折术后发生骨不连的病例及其相关的翻修治疗,探讨分析可能的危险因素,提高对股骨转子间骨折术后骨不连的认识,并为临床翻修治疗骨不连提供合理指导。 方法 回顾搜集浙江大学医学院附属第二医院骨科2010年01月至2015年02月收治的14例股骨转子间骨折术后骨不连患者的病史资料和检查资料,并对翻修术后患者进行随访,统计学分析数据,汇总制作成图表。 结果 我科共收治14例转子间骨折不愈合患者,平均年龄59.3岁；从骨折到翻修平均时间为13.3个月；初次内固定选择包括：髓内钉8例、动力髋螺钉2例、锁定钢板4例,其中3例初次内固定后出现感染；原始骨折按AO分型：A3型7例、A2型2例、A1型5例；初次手术采用髓内固定失败的8例患者中1例予以加用一块小钢板,3例予以全髋置换,4例予以更换为锁定钢板；动力髋螺钉治疗失败的2例患者中1例改为髓内固定,1例予以全髋关节置换术；锁定钢板失败的4例患者中2例更换为动力髋螺钉,1例仅植骨,1例更换为锁定钢板重新固定取髂骨植骨。14例患者术后随访,所有患者骨折均治愈,翻修术前Harris评分平均为30.0±8.7分,末次随访时平均为83.7+7.5分,较术前明显提高,差异显著(P0.05)。 结论 股骨转子间骨折术后骨不连与感染,骨折粉碎程度、骨折端血供破坏,骨折端加压、复位情况以及初始内固定选择相关,针对不同失败原因选择相应的翻修措施可以取得良好的临床效果。
[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.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
[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.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
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