高龄不稳定性股骨转子间骨折的髋关节置换:先置入假体再行骨折内固定  

Hip replacement for senile unstable femoral interochanteric fractures:internal fixation following prosthesis implantation

作　　者：陈戎波[1] 范少地[1] 胡万华[1] 王仁[1] 于杰[1] 周凤金[1] 刘剑[1] 

机构地区：[1]解放军第451医院骨科,陕西省西安市710054

出　　处：《中国组织工程研究与临床康复》2010年第13期2341-2344,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景：近年来人工关节置换成为治疗高龄股骨转子间骨折的一种新方法。以往学者多习惯先处理骨折后置入假体,或先处理小转子,置入假体后再修复大转子。对于加长柄与标准柄长的使用,争论较大。目的：验证人工关节置换治疗高龄不稳定性股骨转子间骨折的治疗效果,观察置换过程中置入假体与固定大小转子骨折块的操作顺序对修复效果的影响。方法：回顾性分析2006-01/2008-12解放军第451医院骨科应用人工关节置换治疗高龄股骨转子间不稳定型骨折28例的临床资料,20例行人工股骨头置换,8例行全髋关节置换,均采用骨水泥型人工关节。人工关节置换后观察X射线片、髋关节功能Harris评分变化及其并发症。结果与结论：全组病例人工关节置换后随访1-4年,平均2.8年,疗效优良率为89.3%,未发现髋内翻、感染、松动、脱位者。人工关节置换能迅速恢复患肢功能,减少并发症的发生。置换要点是大、小转子骨折与人工假体关系的处理,应先置入假体,后以假体为支撑、行骨折内固定;做到假体与股骨近段紧密压配,是置换后假体稳定性的保证,加长柄与标准柄长均可使用。BACKGROUND：In recent years artificial joint replacement surgery has become a new method for the treatment of intertrochanteric fractures of the elderly.In the traditional treatment of internal fixation of senile intertrochanteric fractures,the prosthesis is implanted following fracture treatment,or the small trochanter is treated and the prosthesis is implanted,followed by greater trochanter treatment.It remains controversial about the application of lengthened or standard length stem. OBJECTIVE：To evaluate the effect of artificial joint replacement on elderly patients with unstable intertrochanteric fracture,and observe the influence of the order of prosthesis implantation,small trochanter and greater trochanter treatment during the surgery. METHODS：The clinical data of 28 elderly patients with unstable femoral intertrochanteric fractures treated in Department of Orthopedics,the 451 Hospital of Chinese PLA from January 2006 to December 2008 were retrospectively analyzed,including 20 undergoing artificial joint replacement and 8 undergoing total hip replacement with cemented prosthesis.X-ray,Harris scores of hip joint and complications were observed postoperatively. RESULTS AND CONCLUSION：All patients were followed up for 1 to 4 years（average 2.8 years）,with an excellent and good rate of 89.3%.No coxa vara,infection,loosening or dislocation was found.The surgery can quickly restore limb function and reduce complications.The treatment of greater and small tuberosity fracture and prosthesis is very important.The prosthesis is firstly implanted,followed by internal fixation with the prosthesis as the support.Tightly matching of the proximal femur and prosthesis is essential for the stability of postoperative prosthesis,and lengthened or standard length stem can be used.

关 键 词：人工关节置换 股骨转子间骨折 高龄 髋 不稳定性骨折 髋关节假体 

分 类 号：R318[医药卫生—生物医学工程]