目的观察微创经皮钢板固定技术(minimally invasive percutaneous plate osteosynthesis,MIPPO)结合微创内固定系统(less invasive stabilization system,LISS)钢板治疗股骨远端骨折后膝关节功能及其影响因素。方法回顾性分析2015年1月至2018年12月于成都中医药大学附属眉山医院就诊的且行MIPPO技术结合LISS钢板治疗的股骨远端骨折107例患者临床资料,依据纽约特种外科医院膝关节评分(hospital for special surgery knee score,HSS)分为优良组(HSS评分≥70分)85例和非优良组(HSS评分<70分)22例,采用单因素和多因素logisitic回归分析膝关节功能恢复的影响因素。结果103例患者骨折愈合,平均愈合时间(3.9±0.6)个月;膝关节功能:优55例,良30例,可20例,差7例,优良率为79.44%;单因素分析结果显示年龄、骨折AO分型、手术时机、复位质量、是否行石膏制动以及是否行膝关节持续被动运动训练,是影响MIPPO技术结合LISS钢板治疗股骨远端骨折后膝关节功能恢复的危险因素。logisitic回归分析结果显示年龄≥45岁、骨折AO分型C型、手术时机≥3d、复位质量不满意、未行膝关节持续被动运动训练是MIPPO技术结合LISS钢板治疗股骨远端骨折后膝关节功能恢复的独立危险因素。结论MIPPO技术结合LISS钢板治疗股骨远端骨折后,影响膝关节功能恢复的因素较多,年龄≥45岁、骨折AO分型C型、手术时机≥3d、复位质量不满意、未行膝关节持续被动运动训练均是膝关节功能恢复的独立危险因素。
Deep venous thrombosis （DVT） is an important cause of disability and mortality after major orthopedic surgery. The roles of perioperative treatment and prevention of DVT in patients with femoral neck fractures who require major surgery have not yet been well explored in Chinese clinical practice. Here we report a case of calf muscular venous thrombosis in a 55-year-old woman with femoral neck fracture before surgery. Preventive and treatment measures including the administration of heparin sodium, application of venous foot pump and placement of inferior vena cava filter were taken. The condition of the patient was stable during the perioperative period and the surgery was successful. Besides, postoperative examination showed that the femur healed well and the functional recovery was satisfactory. Our results suggest that femoral neck fracture patients combined with DVT can receive surgery after accurate preoperative assessment and proper preoperative treatment.
Ming Liu Lei Liu Fuguo Huang Yue Fang Gang Zhong Zhou Xiang
