Artificial joint replacement combined with limited internal fixation in treating elderly patients with intertrochanteric fractures
-
摘要: 目的:探讨人工关节置换联合有限内固定治疗老年人转子间骨折的临床效果。方法:选取2012-01-2015-12我科老年人股骨转子间骨折48例,所有患者均采用人工关节置换联合有限内固定的方法治疗,观察、记录其手术时间、出血量、下床时间、住院时间、术后并发症及髋关节功能情况。结果:所有患者均成功完成手术,手术时间为60~90 min,平均手术时间为75 min;术中失血为300~500 ml,平均失血400 ml;患者下地时间为2~5 d,平均下床负重时间为3 d;住院时间为7~21 d,平均住院时间为14 d;其中40例患者获得随访,无患者出现伤口感染、肺部感染、褥疮,仅2例患者出现顽固性疼痛,无患者出现假体松动、脱位,未出现二次骨折。所有患者均能正常行走,其术后髋关节功能Harris评分平均值为88分,其中20例为优(>90分),15例为良(80~89分),3例为中(70~79分),2例为差(<70分)。结论:人工髋关节置换联合有限内固定是治疗老年人股骨转子间骨折的有效方法,具有获得良好的髋关节功能,促进患者早期下床,降低并发症等特点。Abstract: Objective:To discuss the effect of artificial joint replacement combined with limited internal fixation for the treatment of intertrochanteric fractures in the elderly.Method:Forty-eight elderly patients with interthochanteric fractures in our department were chosen between January 2012 and December 2015.All patients were treated with artificial joint replacement combined with limited internal fixation.Observe and record the time of operation,the amount of bleeding,out-of-bed time,hospital stays,postoperative complications and hip function.Result:All patients were completed the operation successfully with an operating time of 60~90 min and the average was 75min;The blood loss was 300~500 ml and the average was 400 ml;The out-of-bed time was 2~5 days and the average was 3 days;The hospital stays was 7~21 days and the average was 14 days.Forty patients received follow-up,no patients appeared wound infection,pulmonary infection,bedsore,only two patients suffered from intractable pain,no patients appeared prosthesis loosening and dislocation and no secondary fractures happened.All patients were able to walk normally,the average Harris score of postoperative hip function was 88,of which 20 were excellent (>90),15 were good (80~89),3 were medium(70~79),and 2 were poor (<70).Conclusion:Artificial hip joint replacement combined with limited internal fixation is an effective method for treating intertrochanteric fractures in the elderly,which can make patients get good hip function,promote patients get out of bed early and reduce complications and so on.
-
-
[1] Singh M, Nagrath A R, Maini P S.Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis[J].J Bone Joint Surg Am, 1970, 52 (3):457-467.
[2] 毛小成, 赵枫.人工股骨头置换联合转子重建术治疗老年人股骨转子间骨折[J].临床军医杂志, 2015, 43 (11):854-855.
[3] 李西成, 焦振清, 潘进社, 等.小切口动力髁螺钉内固定治疗老年股骨逆转子间骨折[J].中华创伤骨科杂志, 2008, 10 (8):789-790.
[4] Carvajal-Pedrosa C, Gómez-Sánchez R C, HernándezCortés P.Comparison of outcomes of intertrochanteric fracture fixation using percutaneous compression plate between stable and unstable fractures in the elderly[J].Orthop Trauma, 2016, 30 (6):201-206.
[5] Yuan G X, Shen Y H, Chen B, et al.Biomechanical comparison of internal fixations in osteoporotic intertrochanteric fracture.A finite element analysis[J].Saudi Med, 2012, 33 (7):732-739.
[6] 李光辉, 夏仁云, 王体沛, 等.动力髋螺钉治疗老年人股骨转子间骨折的手术风险及疗效[J].中国矫形外科杂志, 2005, 13 (20):1538-1539.
[7] Bridle S H, Patel A D, Bircher M, et al.Fixation of intertrochanteric fractures of the femur.A randomised prospective comparison of the gamma nail and the dynamic hip screw[J].J Bone Joint Surg Br, 1991, 73 (2):330-334.
[8] Chan K C, Gill G S.Cemented hemiarthroplasties for elderly patients with intertrochanteric fractures[J].Clin Orthop Relat Res, 2000, 371:206-215.
[9] Babst R, Renner N, Biedemann M, et a1.Clinical result using the tro-chanter stabilizing plate (TSP):the modular extension of the dynamic hip screw (DHS) for intemaofixation of selected unstable imertrochanteric fracture[J].J Orthop Trauma, 1998, 12 (6):392399.
[10] Kim W Y, Han C H, Park J I, et al.Failure of intertrochanteric fracture fixation with a dynamic hip screw in relation to pre-operative fracture stability and osteoporosis[J].Int Orthop, 2001, 25 (6):360362.
[11] Cui Q, Liu Y S, Li D F, et al.Cemented hip hemiarthroplasty clinical observations on unstable intertrochanteric fracture in elderlies[J].Eur J Trauma Emerg Surg, 2016, 42 (5):651-656.
[12] Kumar Gn K, Meena S, Kumar N V, et al.Bipolar hemiarthroplasty in unstable intertrochanteric fractures in elderly:aprospective study[J].J Clin Diagn Res, 2013, 7 (8):1669-1671.
[13] 孙友强, 邵敏, 何伟, 等.人工关节置换与内固定修复老年股骨转子间骨折的Meta分析[J].中国组织工程研究, 2016, 20 (13):1954-1960.
[14] 张晓岗, 阿斯哈尔江·买买提依明, 曹力, 等.非骨水泥型人工关节置换治疗老年不稳定股骨转子间骨折[J].中华骨科杂志, 2012, 32 (7):631-636.
[15] Sinno K, Sakr M, Girard J, et al.The effectiveness of primary bipolar arthroplasty in treatment of unstable intertrochanteric fractures in elderly patients[J].N Am J Med Sci, 2010, 2 (12):561-568.
-
计量
- 文章访问数: 145
- PDF下载数: 299
- 施引文献: 0
下载: