Shah Malkesh D, Kapoor Chirag S, Soni Rishit J, Patwa Jagdish J, Golwala Paresh P
Department of Orthopaedics, Smt. Bhikhiben Kanjibhai Shah Medical Institute & Research Centre, Sumandeep Vidyapeeth, Vadodara, Gujarat, India.
J Clin Orthop Trauma. 2017 Oct-Dec;8(4):308-312. doi: 10.1016/j.jcot.2016.11.005. Epub 2016 Nov 21.
Pertrochanteric fractures are most frequent factures of the proximal femur, accounts for nearly 50% of all proximal femur fractures and are most devastating and also a major cause of disability in elderly. The aim and objective of this study was to evaluate the role of proximal femoral locking compression plate in unstable proximal femur fractures.
A total of 20 cases were included in our study (M:F - 16:4), who suffered proximal femur fracture due to various modalities and all of them were operated using proximal femoral locking compression plate. This proximal femoral fractures included unstable - intertrochanteric with subtrochanteric extension and subtrochanteric with intertrochanteric extensions as well as one case with intertrochanteric, subtrochanteric and neck of femur fracture. Patients were followed up regularly and minimum follow-up period was 12 months. Patients were given physiotherapy and partial weight bearing was started after 6 weeks postoperatively or after union was achieved. The outcome was evaluated as per Harris Hip Score and radiological union.
Among 20 cases with average age of 55.3 ± 17.9 years, treated with PF-LCP, the average time of union 18.75 ± 3.67 weeks was achieved. We got 10 excellent, 3 good, 3 fair and 4 poor result with average Harris Hip Score of 80.2 ± 28.54 with 65% good to excellent result with average Post-operative Neck Shaft Angle of 124.150 ± 17.880 and with 45% rate of complication which included four cases of superficial infection and two cases of deep infection and late complications like four cases of non-union, deformity - three cases of coxa vara and 2 cases of coxa valga, with patients having more than one complication in them.
PF-LCP is not recommended as a definitive implant but can be used as an alternative for the treatment of unstable proximal femoral fractures when there is no option available for other routinely used implants. Despite of its complications, PF-LCP is used where all implants fail.
转子周围骨折是股骨近端最常见的骨折,占所有股骨近端骨折的近50%,是最具破坏性的骨折,也是老年人致残的主要原因。本研究的目的是评估股骨近端锁定加压钢板在不稳定股骨近端骨折中的作用。
本研究共纳入20例患者(男∶女 = 16∶4),这些患者因各种原因导致股骨近端骨折,均采用股骨近端锁定加压钢板进行手术治疗。这些股骨近端骨折包括不稳定型转子间骨折伴转子下延伸、转子下骨折伴转子间延伸,以及1例转子间、转子下和股骨颈骨折。对患者进行定期随访,最短随访期为12个月。患者接受物理治疗,术后6周或骨折愈合后开始部分负重。根据Harris髋关节评分和影像学愈合情况评估结果。
20例平均年龄为55.3±17.9岁的患者接受了股骨近端锁定加压钢板(PF-LCP)治疗,平均愈合时间为18.75±3.67周。我们得到10例优、3例良、3例可、4例差的结果,平均Harris髋关节评分为80.2±28.54,65%的结果为良至优,术后平均颈干角为124.150±17.880,并发症发生率为45%,包括4例浅表感染、2例深部感染以及4例骨不连、3例髋内翻和2例髋外翻等晚期并发症,部分患者存在多种并发症。
不推荐将PF-LCP作为确定性植入物,但当没有其他常规使用的植入物可供选择时,可作为治疗不稳定股骨近端骨折的替代方案。尽管存在并发症,但在所有植入物均失败的情况下仍可使用PF-LCP。