Simecek M, Simecek K, Svoboda V, Peterka T
Ortopedicko-traumatologické oddelení Nemocnice Písek.
Rozhl Chir. 2010 Feb;89(2):150-8.
The authors present their experiences with the treatment of trochanteric fractures (31A1.1-31A3.3) using the Gotfried's percutaneous compression plate (PCCP). The authors evaluate some parameters at other kinds of osteosynthesis in the same indication.
We made 230 osteosynthesis of trochanteric fractures in the period from August 2004 to December 2008. The PCCP was used 179x (72x type 31A1.1-3, 90x type 31A2.1-3, 17x type 31A3.1-3). The other kinds of osteosynthesis were used 51x (DHS 40x, PFN 9x and condylar plate 2x) in the same indication. The mean age, the hospitalization time, the interval admission - operation, wound complications and the lethality within 30 days, 90 days and 1 year were evaluated. Some patients were lost to follow up or died. The bone healing was evaluated at 119 PCCP and 43 other osteosynthesis, which remained in the study.
The stabilisation is done via two 2-3 cm long incisions. The plate, assembled on a introducer, is inserted through the proximal incision. The special hook for the plate fixation to the bone, two angular stable self-cutting neck screws and three diaphyseal screws are inserted from the distal incision.
The first value concerns the PCCP, the value in brackets concerns the other osteosynthesis. Number 179 (51).The mean age 78.9 (76.2) years, the interval admission - operation 0.95 (1.12) days, the hospitalization time 15.3 (16.5) days, the wound hematoma and revision 3 (1), the wound infection and revision 1 (1). Died within 30 days 8.4% (5.9%), within 90 days 13 % (13.7%), within 1 year 33.9% (29.2%). All 119 patients with PCCP (including 15 type AO 31A3) were healed within 8 months. No pseudoarthrosis, collaps or cut-out were noted at the PCCP group. Four failures, caused by an unsuitable indication or by a surgeon error, were noted in the group of the other osteosynthesis.
The advantage of the PCCP is minimally invasive technique and rotation stability. The authors proved that the PCCP reduces and fixes the fractured lateral wall at high subtrochanteric fractures (31 A3.1-3). The wall is healed and prevents collapse. The authors indicate AO type 31A3 fractures to the PCCP unlike the author of the method.
The study confirmed that the PCCP is a minimally invasive osteosynthesis suitable for all types of trochanteric fractures. All 119 followed up patients including 15 with 31 A3.1-3 fractures were healed.
作者介绍了使用戈特弗里德经皮加压钢板（PCCP）治疗转子间骨折（31A1.1 - 31A3.3）的经验。作者评估了相同适应症下其他类型骨固定术的一些参数。
2004年8月至2008年12月期间，我们对转子间骨折进行了230例骨固定术。使用PCCP 179例（72例31A1.1 - 3型，90例31A2.1 - 3型，17例31A3.1 - 3型）。相同适应症下使用其他类型骨固定术51例（动力髋螺钉40例，股骨近端髓内钉9例，髁钢板2例）。评估了平均年龄、住院时间、入院至手术间隔、伤口并发症以及30天、90天和1年内的死亡率。部分患者失访或死亡。对研究中剩余的119例使用PCCP和43例其他骨固定术的患者进行了骨愈合评估。
通过两个2 - 3厘米长的切口进行固定。组装在导引器上的钢板通过近端切口插入。从远端切口插入用于将钢板固定到骨上的特殊钩子、两枚角度稳定的自攻颈螺钉和三枚骨干螺钉。
第一个数值涉及PCCP，括号内数值涉及其他骨固定术。数量179（51）。平均年龄78.9（76.2）岁，入院至手术间隔0.95（1.12）天，住院时间15.3（16.5）天；伤口血肿及再次手术3（1）例，伤口感染及再次手术1（1）例。30天内死亡8.4%（5.9%），90天内死亡13%（13.7%），1年内死亡33.9%（29.2%）。所有119例使用PCCP的患者（包括15例AO 31A3型）均在8个月内愈合。PCCP组未发现假关节形成、塌陷或螺钉穿出。在其他骨固定术组中发现4例因适应症选择不当或手术医生失误导致的失败病例。
PCCP的优点是微创技术和旋转稳定性。作者证明PCCP可对高位转子下骨折（31A3.1 - 3）的骨折侧壁进行复位和固定。侧壁愈合，防止塌陷。与该方法的作者不同，作者将AO 31A3型骨折指证为使用PCCP。
该研究证实PCCP是一种适用于所有类型转子间骨折的微创骨固定术。所有119例接受随访的患者，包括15例31A3.1 - 3型骨折患者均已愈合。
