Berkenbaum I, El Banna S
Service de Chirurgie Orthopédique, CHU de Charleroi, Site André Vésale, Montigny-le-Tilleul.
Rev Med Brux. 2004 Feb;25(1):40-6.
In terms of frequency, trochanteric fractures represent one of the most common problems in adult traumatology. Considering their physical and psychological consequences, and the patients mean age, they constitute one of the most acute public health problems faced by the elderly. Surgical reduction is currently considered as preferred treatment. Stable fixation of the fracture focus by osteosynthesis allows early mobilization of the treated member, central axis of the body. A series of 35 patients with a mean age of 78, surgically treated with Gotfried percutaneous plating between June 1998 and August 2000, have been followed-up to full fracture healing. The fractures were divided according to the AO fracture classification system. All patients were treated with this minimally invasive technique, which consists of introducing a percutaneous compression plate through two tiny stab incisions. The results take into account the reduction quality, mean hospital stay, evolution, perioperative and postoperative complications. The patients early weight bearing has been possible from the third day after the operation. The mean perioperative blood loss was estimated to 90 mL. The mean mortality rate during hospital stay was 5.7%, and 11.4% after three months. The complications encountered comprised two cephalic screw cutouts, two plate breakages and one surgical wound infection. Linked to the quality of the bone, regardless of the material used, these complications are likely to those observed with other methods. This short sample allows to consider the percutaneous compression plating as a valid surgical technique, though it can be opposed the same critics than other trochanteric fractures treatments. However, it offers the benefits of a closed and rapidly performed surgical technique, theoretically beneficial to improve the vital prognosis for this type of fracture.
就发生率而言,转子骨折是成人创伤学中最常见的问题之一。考虑到其对身体和心理的影响以及患者的平均年龄,它们构成了老年人面临的最严重的公共卫生问题之一。目前,手术复位被视为首选治疗方法。通过骨固定术对骨折部位进行稳定固定,可使身体中轴线的患侧肢体早期活动。对1998年6月至2000年8月间采用戈特弗里德经皮钢板固定术进行手术治疗的35例平均年龄为78岁的患者进行了随访,直至骨折完全愈合。骨折根据AO骨折分类系统进行划分。所有患者均采用这种微创技术治疗,该技术包括通过两个微小的刺切口插入一枚经皮加压钢板。结果考虑了复位质量、平均住院时间、病情进展、围手术期和术后并发症。患者术后第三天即可早期负重。围手术期平均失血量估计为90毫升。住院期间的平均死亡率为5.7%,三个月后为11.4%。遇到的并发症包括两枚头钉穿出、两块钢板断裂和一例手术伤口感染。无论使用何种材料,这些并发症都与骨质质量有关,可能与其他方法观察到的并发症相似。尽管这种简短的样本研究可能会受到与其他转子骨折治疗方法相同的批评,但它使经皮加压钢板固定术被视为一种有效的手术技术。然而,它具有闭合且快速实施的手术技术的优点,理论上有利于改善此类骨折的生命预后。