Antonini G, Giancola R, Berruti D, Blanchietti E, Pecchia P, Francione V, Greco P, Russo T C, Pietrogrande L
Orthopaedic and Trauma Department, Azienda Ospedaliera San Carlo Borromeo, Via Pio II 3, 20153, Milan, Italy,
Strategies Trauma Limb Reconstr. 2013 Apr;8(1):13-20. doi: 10.1007/s11751-013-0159-6. Epub 2013 Mar 31.
The standard surgical management of hip fractures is associated with tissue trauma and bleeding which are added to the fracture injury. The percutaneous compression plate (PCCP) is a minimally invasive device that has been demonstrated in previous studies to reduce postoperative complications and blood loss. This prospective, multi-center, observational study assessed clinical and functional outcomes with PCCP as treatment for trochanteric fractures. Patients with a stable or unstable proximal femoral fracture of type AO 31.A1 or 31.A2 were enrolled in eight hospitals in Italy. The primary outcome of interest was the recovery of the pre-fracture functional status at 1-year follow-up; secondary outcomes of interest included blood transfusions, surgical time, complications, and mortality. A total of 273 patients were enrolled. The ASA score was 3 or 4 in 72.5 % of patients. The mean surgical time was 44.1 min; the mean post-surgery blood transfusions was 0.9 units. At 1 year, 48 patients (17.6 %) died, 28 (10.2 %) were lost to follow-up, 4 patients (1.5 %) were excluded, hence 193 patients (70.3 %) were available for final evaluation. At the 1-year follow-up visit, 51.9 % of patients recovered or improved their pre-fracture modified Harris Hip Score, 49.1 % of patients improved or maintained their walking abilities, and 66.6 % of patients residing at home pre-surgery maintained their domicile. The overall mortality rate was 17.6 %. Major complications included two fracture collapses, one excessive sliding of the cephalic screw leading to a partial fracture collapse and one back-out of the diaphyseal screw. This study demonstrates that treatment of trochanteric fractures with PCCP gives good outcomes and significant advantages such as low blood loss, short surgical time, low risk of complications, and good functional recovery in the majority of the patients.
髋部骨折的标准手术治疗会造成组织创伤和出血，这会加重骨折损伤。经皮加压钢板（PCCP）是一种微创器械，先前的研究已证明其可减少术后并发症和失血量。这项前瞻性、多中心观察性研究评估了使用PCCP治疗转子间骨折的临床和功能结果。意大利八家医院纳入了AO 31.A1或31.A2型稳定或不稳定股骨近端骨折患者。主要关注的结局是1年随访时骨折前功能状态的恢复情况；次要关注的结局包括输血情况、手术时间、并发症和死亡率。共纳入273例患者。72.5%的患者ASA评分为3或4。平均手术时间为44.1分钟；术后平均输血量为0.9单位。1年时，48例患者（17.6%）死亡，28例患者（10.2%）失访，4例患者（1.5%）被排除，因此193例患者（70.3%）可进行最终评估。在1年随访时，51.9%的患者恢复或改善了骨折前改良Harris髋关节评分，49.1%的患者改善或维持了行走能力，66.6%术前居家的患者维持了原居住状态。总死亡率为17.6%。主要并发症包括两例骨折塌陷、一例股骨头螺钉过度滑动导致部分骨折塌陷以及一例骨干螺钉退出。本研究表明，使用PCCP治疗转子间骨折可取得良好效果，具有显著优势，如失血量少、手术时间短、并发症风险低以及大多数患者功能恢复良好。
