Department of Orthopaedics, Xinfeng County People's Hospital, Ganzhou, Jiangxi 341600, China.
Biomed Res Int. 2022 Aug 26;2022:8145438. doi: 10.1155/2022/8145438. eCollection 2022.
To investigate the treatment and clinical efficacy of postoperative plate fracture and in situ fracture of the femoral stem.
We have retrospectively analyzed the clinical data, revised surgery information, and clinical efficacy of patients with postoperative plate fracture of the femoral stem in our hospital. A total of 33 cases were included whose original fractures were located in the upper and cadaveric femur and treated with paralleling intramedullary pins for revision surgery, as well as patients whose original fractures were located in the lower femur which were fixed with retrograde intramedullary nailing or anatomical locking and compression splints in the distal femur. For the selection of bone grafting, the original fracture site with Fernadez-Esteve scab grades I and II was treated with an autologous iliac bone graft. Postoperatively, patients were evaluated for fracture healing time, the clinical outcome of the affected limb, and complications in the iliac bone donor area.
All patients were followed up until fracture healing, and all patients achieved clinical healing with a healing rate of 100% and a mean healing time of 6.3 months. No internal fixation failure such as rebreakage or loosening of the internal fixation occurred in all patients during the follow-up period. According to the Tohner-Wrnch criteria, 23 cases were excellent, 10 cases were good, and 0 cases were poor, with an excellent rate of 100%. Complications in the autologous iliac bone donor area amounted to 36.7%.
For patients with original fractures located in the upper femoral segment or cadre, it is recommended to perform revision surgery with a paralleling intramedullary pin, while patients with original fractures located in the lower femoral segment are fixed with the retrograde intramedullary nailing or an anatomical type of distal femoral locking and compression splint. Patients with postoperative plate fractures of the femoral stem do not require routine autologous bone grafting for revision surgery.
探讨股骨柄术后钢板骨折和原位骨折的治疗及临床疗效。
回顾性分析我院股骨柄术后钢板骨折患者的临床资料、翻修手术信息及临床疗效。共纳入 33 例患者，其中原始骨折位于股骨干上段及骨干的患者采用平行髓内钉进行翻修手术，原始骨折位于股骨干下段的患者采用逆行髓内钉或解剖锁定加压接骨板固定于股骨远端。对于植骨的选择，Fernandez-Esteve 痂 grades I 和 II 的原始骨折部位采用自体髂骨植骨。术后评估骨折愈合时间、患肢临床疗效及供区髂骨并发症。
所有患者均随访至骨折愈合，所有患者均达到临床愈合，愈合率为 100%，平均愈合时间为 6.3 个月。在随访期间，所有患者均未发生内固定失败，如内固定再断裂或松动。根据 Tohner-Wrnch 标准，23 例为优，10 例为良，0 例为差，优良率为 100%。自体髂骨供区并发症发生率为 36.7%。
对于原始骨折位于股骨干上段或骨干的患者，建议采用平行髓内钉进行翻修手术，而原始骨折位于股骨干下段的患者采用逆行髓内钉或解剖型股骨远端锁定加压接骨板固定。对于股骨柄术后钢板骨折患者，翻修手术不需要常规进行自体骨移植。
