股骨近端锁定加压钢板固定股骨转子下骨折的结果

Mymensingh medical journal : MMJ Pub Date : 2024-10-01
M Sonaullah, M S Islam, M A Ali, M M M Rahman, M N Afsar, M I H Shakil, M K K Khan, M Hoque
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引用次数: 0

摘要

股骨转子下骨折的治疗是一项挑战。股骨转子下骨折约占所有髋部骨折的 10.0% 至 34.0%,并发症发生率较高。该区域主要由皮质骨组成,应力较大,因此愈合缓慢。由于骨折部位太近,股骨干植入物无法对其进行充分控制,而转子间骨折部位太远,植入物无法对其进行控制。这种骨折的内在不稳定性和肌肉的力量加上粉碎的内侧小腿,使骨折有曲折塌陷的趋势。髓外植入物的植入失败率较高,而髓内钉则不适合短近段和宽髓质管的情况。最近,股骨近端锁定加压钢板(PF-LCP)被用于治疗股骨近端骨折,包括转子下骨折。它在骨折愈合、减少并发症和早期康复方面效果显著。本研究旨在评估 PF-LCP 治疗骨折的愈合率和所需时间,并确定围手术期参数。这项前瞻性研究于 2019 年 3 月至 2020 年 9 月在迈门辛医学院医院通过非随机目的性抽样进行。共纳入 25 名年龄在 18 岁以上的闭合性转子下骨折患者,不分性别,但病理骨折和多发伤患者不在研究范围内。通过惠兰(Whelan)胫骨骨折放射联合评分法(RUST)评估联合状态;根据前后位和侧位X光片(X光)评估四个骨皮质的愈合情况。实体皮质得分相加得出总分;4分为最低分,表明骨折未愈合;12分为最高分,表明骨折已愈合。患者的平均年龄为(42.04±14.97)岁,年龄范围为 22-70 岁。大部分患者为男性(60.0%),大部分受伤原因(64.0%)为道路交通事故,大部分骨折为 Seinsheimer III 型(48.0%)。平均手术时间为 121.92 分钟,随访时间为 41.12 周(24-48 周),骨折愈合时间为 14.16 周(11-28 周)。根据 RUST 评分,骨折愈合率为 88.0%,延迟愈合率为 12.0%,无不愈合。有两名患者出现表皮伤口感染,没有植入失败。本研究认为,PF-LCP 是治疗股骨转子下骨折的一种安全可靠的植入物。
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Results of Subtrochanteric Femoral Fractures Fixation by Proximal Femoral Locking Compression Plate.

The treatments of subtrochanteric femoral fractures are a challenge. It accounts about 10.0% to 34.0% of all hip fractures with a high complication rate. This area consists of mostly cortical bone with high stress generation thus heal slowly. The fracture is too proximal to adequately control with implants for femoral shaft and too distal to control with implants for intertrochanteric fractures. The intrinsic insecurity of this fracture and forces of the muscles with comminuted medial calcar is giving the fracture a tendency to varus crumple. Extramedullary implants are associated with higher rate of implant failure while intramedullary nails are not suitable for short proximal segment and wide medullary canal. Recently proximal femoral locking compression plate (PF-LCP) has been applied in treatment of proximal femur including subtrochanteric fractures. It has an excellent result in respect of union, fewer complications and early rehabilitation. The aim of this study was to assess the rate and time taken for union of fractures by PF-LCP and determine perioperative parameters. This prospective study was conducted from March 2019 to September 2020 at Mymensingh Medical College Hospital through non randomized purposive sampling. Total 25 patients aged above 18 years irrespective of sex with closed subtrochanteric fracture were included but pathological fractures, multiple injuries were excluded from the study. Union status evaluated by Radiographic Union Score for Tibial (RUST) fracture of Whelan; where antero-posterior and lateral radiographs (X-ray) based assessment of healing of the four cortices done. The entity cortical scores were added to give an entire score; 4 being the least amount demonstrating fracture are positively not healed and 12 being the highest score representing that the fracture is positively healed. The mean age of the patients was 42.04±14.97 years with range 22-70 years. Majority of patients were male (60.0%) and most of injury (64.0%) due to road traffic accident with most fractures was Seinsheimer type III (48.0%). Average operative time was 121.92 minutes, follow up period was 41.12 weeks (24-48 weeks) and time taken for union was 14.16 weeks (11-28 weeks). According to RUST scores; fracture union rate 88.0% with delayed union 12.0% and no nonunion. There were two patients with superficial wound infection and no implant failure. This study concludes that PF-LCP is a safe and reliable implant for the treatment of subtrochanteric femoral fractures.

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