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目的探讨干骺端加压锁定钢板联合空心钉内固定治疗大龄儿童股骨粗隆下骨折的临床疗效。方法自2007-08—2011-08采用切开复位干骺端加压锁定钢板联合空心钉内固定治疗大龄儿童新鲜、单侧闭合性股骨粗隆下骨折18例。直视下复位成功后用克氏针临时固定,选用大小合适的干骺端加压锁定钢板根据股骨近端角度预弯,将钢板贴伏于股骨外侧,在近端钢板孔内用1或2枚空心钉导针置入股骨颈长轴方向,依次固定钢板螺钉,并经导针置入空心钉。结果本组手术时间45~80 min,平均55 min。术中出血量60~150 ml,平均70 ml。手术切口6~10 cm,平均7 cm。18例均获得完整随访,随访时间12~60个月,平均28个月。所有骨折均获得骨性愈合,骨折愈合时间6~14周,平均8周。均无骨折延迟愈合、骨不连、深部感染、髋内翻、旋转畸形及髋、膝关节功能障碍等并发症发生。其中1例出现双下肢不等长(长度差10 mm),经延长26个月的随访观察,双下肢恢复等长。末次随访时按髋关节功能Sanders评分评定疗效:优15例,良3例。结论大龄儿童股骨粗隆下骨折的临床治疗较为棘手,切开复位干骺端加压锁定钢板联合空心钉内固定是一种疗效确切的手术治疗方法。
Objective To investigate the clinical effect of metaphyseal compression locking plate and cannulated screw fixation for the treatment of elderly patients with subtrochanteric fracture. Methods From August 2007 to August 2011, 18 patients with fresh and unilateral closed intertrochanteric fractures were treated with open reduction and metaphyseal compression locking plate and cannulated screw fixation. Under direct vision after the success of the temporary fixation with Kirschner wire, select the appropriate size of the metaphyseal compression locking plate preload according to the proximal femoral angle, the plate affixed to the outside of the femur in the proximal hole with 1 or 2 Hollow nail guide pin into the long axis of the femoral neck, followed by fixation of steel screws, and guide pins into hollow nails. Results The operation time 45 ~ 80 min, an average of 55 min. Intraoperative bleeding 60 ~ 150 ml, an average of 70 ml. Surgical incision 6 ~ 10 cm, an average of 7 cm. Eighteen cases were followed up for 12 to 60 months with an average of 28 months. All fractures were bony union, fracture healing time 6 to 14 weeks, an average of 8 weeks. No fracture delayed union, nonunion, deep infection, hip varus, rotational deformity and hip, knee dysfunction and other complications. One case showed unequal length of both lower extremities (length difference 10 mm). After prolonged 26 months of follow-up observation, both lower extremities recovered. The final follow-up by the Sanders score hip function evaluation: excellent in 15 cases, good in 3 cases. Conclusion The clinical treatment of elderly patients with subtrochanteric fractures is more difficult. Open reduction and metaphyseal compression locking plate combined with hollow screw fixation is an effective surgical treatment.