Carbon fiber external fixator in repair of elderly femoral intertrochanteric fracture: a short-term follow-up of biocompatibility

doi:10.3969/j.issn.2095-4344.2015.08.010

Abstract

Abstract:

BACKGROUND: External fixator has many advantages in treatment of fractures in the clinic, such as minimally invasive surgical techniques, less radiation exposure, sufficient fixation and closed reduction. Therefore, external fixator for intertrochanteric fracture possibly has some advantages.

OBJECTIVE: To explore the advantage of percutaneous pinning carbon fiber external fixator in repair of intertrochanteric fracture in the elderly.

METHODS: A total of 89 cases of elderly patients with intertrochanteric fractures received external fixator using percutaneous pinning carbon fiber external fixation program. After fixation, all patients underwent hip joint functional exercise. The recovery of hip function was assessed using Harris score at 1, 6 and 12 months after fixation. Simultaneously, imaging evaluation was conducted before and after screw placement in patients.

RESULTS AND CONCLUSION: A total of 89 patients were followed up for 1 to 2 years. One case died due to heart disease. Harris score was 54.3±8.3 before implantation, 66.7±6.4 at 1 month after implantation, 75.5±7.3 at 6 months, and 85.4±7.6 at 12 months. The recovery of joint function was good. Radiographic results displayed that with prolonged time of healing, the hip joint function recovered well. Two cases suffered from mild irritating pain surrounding the nail. Three cases experienced screw loosening and displacement. Six cases suffered from pin tract infection. One case had inflammation surrounding regional nail hole. These results confirmed that external fixation of carbon fiber rods in elderly patients with high risk of intertrochanteric fracture, but there are still adverse reactions such as pin tract infection and loosing.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

全文链接：

Key words: Femoral Fractures, Fracture Fixation, External Fixators, Fracture Healing

CLC Number:

R318

Li Yu-gang. Carbon fiber external fixator in repair of elderly femoral intertrochanteric fracture: a short-term follow-up of biocompatibility[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(8): 1200-1205.

Figures/Tables 2

2.1 参与者数量分析 89例采用碳纤维外固定支架治疗的股骨转子间骨折患者随访1至2年，其中1例患者确诊为缺血性心脏病后，于外固定后17个月时因心肌梗死死亡。 2.2 临床疗效分析本组患者手术时间40-120 min，平均70 min；置换过程中出血量为30-150 mL，平均95 mL，置换后未用引流。术后3 d有下床活动患者，恢复到正常生活状况的时间为20-35 d，平均28 d；骨折愈合的平均时间为3个月。 2.3 髋关节功能Harris评分固定前Harris评分均较低，固定后1个月髋关节功能有所改善，随着骨折愈合时间的延伸，髋关节功能恢复良好，6个月时已基本恢复正常，12个月时Harris评分已达85.4±7.6，关节功能恢复良好，见表1。 2.4 典型病例病例1：男性患者，77岁，车祸撞击后右侧髋关节疼痛，肿胀，活动困难3 h入院，经X射线平片诊断：右侧转子间骨折，患者伴有高血压、心肌梗死等合并症，采用碳纤维外固定支架固定后随访24个月，髋关节功能恢复良好，见图2。病例2：男性患者，84岁，摔伤后右侧髋关节疼痛，肿胀，活动困难5 h入院，经X射线平片诊断：右侧转子间骨折伴股骨近端螺旋形骨折，患者伴肾功能障碍，并意识不清，家属选用碳纤维外固定支架固定后随访16个月，髋关节功能基本恢复，见图3。 2.5 患者对碳纤维外固定架的生物相容性反应、不良事件及并发症外固定后随访12个月时，外固定支架拆除。89例患者中有2例出现钉周刺激性轻度疼痛，给止痛药后缓解；3例6个月后外固定钉松动、移位，入院紧钉复查未再松动。病例中Ⅰ、Ⅱ度针道感染者共4例，Ⅲ度感染者2例，经服用抗生素或冲洗针道后针口全部愈合，未出现骨感染。固定后4周1例出现局部钉孔周围炎症反应，范围在钉周 3 mm内，但该材料无组织液腐蚀表现，给予消炎后好转。外固定架固定钉部在固定后调整后轻微磨损痕迹，未发生降解，未见明显退化，无锈迹。"

References

[1] 吴勇刚,王科学,鲜成树,等. 两种内固定方法治疗高龄股骨转子间不稳定骨折的疗效分析[J]. 骨科,2014,5(1):36-39.
[2] 符国良,李俊,孟志斌,等. 解剖型锁定钢板与股骨近端防旋髓内钉内固定治疗股骨粗隆间骨折的58例临床疗效观察[J]. 医学研究杂志,2014,43(4):145-147.
[3] Kristek D, LovrieI, Kristek J, et al. The proximal femoral nail antirotation (PFNA) in the treatment of proximal femoral fractures. Coil Antropol. 2010;34(3):937-940.
[4] Ata A, Valerian BT, Lee EC, et al. The effect of diabetes mellitus on surgical site infections after colorectal and noncolorectal general surgical operations. Am Surg. 2010; 76(7):697-702.
[5] Zhou F,Zhang ZS,Yang H,et al.Less invasive stabilization system (LISS) versus proximal femoral nail anti-rotation (PFNA) in treating proximal femoral fractures:a prospective randomized study. J Orthop Trauma. 2012; 26(3):155-162.
[6] Connelly CL,Archdeacon MT.The lateral decubitus approach for complex proximal femur fractures:anatomic reduction and locking plate neutralization:A technical trick. J Orthop Trauma. 2012;26(4):252-257.
[7] 韦旭明,孙振中,宋骁军. 经皮加压钢板与股骨近端防旋髓内钉治疗外侧壁危险型股骨粗隆间骨折的病例对照研究[J]. 中国骨伤,2013,12(26):981-984.
[8] 闫玉明,廖勇,张伟平.等.解剖型锁定钢板治疗骨质疏松singllI、Ⅱ度股骨粗隆间骨折疗效分析[J].中国骨与关节损伤杂志,2011, 26(10):881-883.
[9] 刘刚,刘金星,张中发. 动力髋螺钉、股骨近端锁定加压钢板以及防旋股骨近端髓内钉治疗老年股骨转子间骨折90例临床分析[J]. 中国综合临床,2013,29(6):622-625.
[10] 李健,张振山,赵洪普,等. 股骨近端锁定解剖钢板与传统动力髋螺钉置入内固定治疗股骨转子间骨折的比较[J]. 中国组织工程研究与临床康复,2010,14(35):6627-6631.
[11] Schipper IB, Marti RK, van der Werken C. Unstable trochanteric femoral fractures:extramedullary or intramedullary fixation. Review of literature. Injury. 2004;35(2): 142-151.
[12] 刘伸.外固定架治疗高龄股骨颈基底部转子间骨折临床观察[J]. 河北医学,2014,20(5):816-818.
[13] Guo Q, Shen Y, Zong Z, et al. Percutaneous compression plate versus proximal femoral nail anti-rotation in treating elderly patients with intertrochanteric fractures: a prospective randomized study. J Orthop Sci. 2013;18(6):977-986.
[14] Luo F, Shen J, Xu J, et al. Treatment of AO/OTA 31-A3 intertrochanteric femoral fractures with a percutaneous compression plate. Clinics (Sao Paulo). 2014;29(8): 1639-1641.
[15] 肖文倩.单侧多功能外固定支架治疗骨创伤并发症及对策分析[J]. 湖南中医药大学学报,2013,33(8):41-42.
[16] 陈大伟,李兵,俞光荣. Pilon骨折的研究现状和外固定支架治疗[J]. 中华创伤杂志,2013,29(10):1011-1014.
[17] Hou Z, Shi J, Ye H, Pan Z. Treatment of unstable intertrochanteric fractures with percutaneous non-contact bridging plates.Int J Surg. 2014;12(5):538-543.
[18] Braun KF, Siebenlist S, Sandmann GH, et al. Functional Results Following Titanium Elastic-Stable Intramedullary Nailing (ESIN) of Mid-Shaft Clavicle Fractures. Acta Chir Orthop Traumatol Cech. 2014;81(2):118-121.
[19] Xu X, Li X, Liu L, et al. A meta-analysis of external fixator versus intramedullary nails for open tibial fracture fixation. J Orthop Surg Res. 2014;9:75.
[20] 席天平,凌坤,马克,等. 自制外固定器固定股骨转子间骨折的生物力学研究[J]. 实用骨科杂志,2012,18(10):904-908.
[21] Shen J, Luo F, Sun D, et al. Mid-term results after treatment of intertrochanteric femoral fractures with percutaneous compression plate (PCCP).Injury. 2014.
[22] Zhang L, Shen J, Yu S,et al. Percutaneous compression plate versus dynamic hip screw for treatment of intertrochanteric Hip fractures: a meta-analyse of five randomized controlled trials. Sci World J. 2014;2014:512.
[23] 唐克,段雄波. 动力髋螺钉、Gamma钉、外固定架3种固定物治疗老年股骨转子间骨折[J].中国组织工程研究与临床康复, 2010, 14(52):9845-9848.
[24] 景孟军,严利民,蔡水奇,等. 加压空心钉式外固定架与动力髋螺钉治疗老年股骨转子间骨折的生物力学比较[J]. 临床骨科杂志, 2012,15(4):455-457.
[25] 孙政尧,孙晓雷,贺彩霞,等. 外固定架联合负压封闭引流技术治疗GustiloⅢB型骨折及其并发症的临床研究[J]. 中国医药指南, 2014,12(2):184-185.
[26] Tan LA, Kasliwal MK, Wewel J, et al. Minimally invasive surgery for synchronous, same-level lumbar intradural- extramedullary neoplasm and acute disc herniation. Neurosurg Focus. 2014;37 Suppl 2:16.
[27] 苗旭漫,南军,崔海峰,等.股骨转子间骨折滑动加压外固定器的设计及生物力学评价[J].中国骨与关节损失杂志,2008,23(3): 192-195.
[28] 刘爱国,谷文光,邓亮,等.不同手术方法治疗老年股骨转子间骨折疗效分析[J].中国矫形外科杂志,2012,20(12):1072-1075.