Peyser Amos, Weil Yoram, Liebergall Meir, Mosheiff Rami
Orthopedic Surgery Department, Hadassah Hebrew University Medical School, Jerusalem, Israel.
Oper Orthop Traumatol. 2005 Jun;17(2):158-77. doi: 10.1007/s00064-005-1127-1.
Fixation of intertrochanteric fractures by a minimally invasive technique using the Percutaneous Compression Plate (PCCP) allowing anatomic reduction and immediate postoperative weight bearing.
Intertrochanteric fractures.
Intertrochanteric fractures that cannot be reduced by closed manipulation, subtrochanteric and reverse oblique fractures (AO/OTA 31-A3).
Placement of patient on a fracture table with a posterior reduction device (PORD) supporting the fracture. Reduction of the fracture by closed manipulation. Percutaneous insertion of the plate through a lateral proximal incision. Adaptation of the plate to the lateral aspect of the proximal femoral shaft with a bone clamp inserted through a second, more distal incision. Insertion of telescoping compression neck screw through the plate into the neck and securing of plate to the femoral shaft with three additional screws. Finally, completion of fracture fixation with second neck screw.
Of 130 patients with intertrochanteric fractures treated using the described technique at the Orthopedic Surgery Department Hadassah University Hospital, Jerusalem, Israel, between May 2000 and December 2001, 108 were available for this study. Patients' age averaged 81 years (+/- 8 years). Mean surgical time was 67 min and mean hospital stay 11.5 days. 40% of patients did not require a transfusion during hospitalization, while 8.3% needed more than three units of packed cells. Complications occurred in four patients: two implant failures that were successfully revised with a Compression Hip Screw, one nonunion treated with hip arthroplasty; the fourth patient had a shortening of 3 cm needing a heel lift. Three patients developed an infection, one requiring surgical debridement.
采用经皮加压钢板（PCCP）微创技术固定股骨转子间骨折，实现解剖复位并允许术后立即负重。
股骨转子间骨折。
无法通过闭合手法复位的股骨转子间骨折、转子下骨折和反向斜形骨折（AO/OTA 31 - A3）。
将患者置于骨折手术台上，使用后方复位装置（PORD）支撑骨折部位。通过闭合手法复位骨折。经皮从近端外侧切口插入钢板。通过第二个更靠远端的切口插入骨钳，将钢板适配于股骨近端外侧骨干。通过钢板向颈部插入可伸缩加压颈螺钉，并用另外三枚螺钉将钢板固定于股骨干。最后，用第二枚颈螺钉完成骨折固定。
2000年5月至2001年12月期间，以色列耶路撒冷哈达萨大学医院骨科采用上述技术治疗了130例股骨转子间骨折患者，其中108例可纳入本研究。患者平均年龄81岁（±8岁）。平均手术时间为67分钟，平均住院时间为11.5天。40%的患者住院期间无需输血，而8.3%的患者需要超过三个单位的浓缩红细胞。4例患者出现并发症：2例植入物失败，成功采用加压髋螺钉翻修；1例骨不连采用髋关节置换术治疗；第4例患者短缩3厘米，需要使用足跟垫。3例患者发生感染，1例需要手术清创。
