双极股骨头置换合并张力带钢丝固定治疗高龄骨质疏松性股骨转子间骨折  

BIPOLAR FEMORAL HEAD REPLACEMENT COMBINED WITH TENSION BAND WIRE FIXATION FOR INTERTROCHANTERIC FRACTURE IN ELDERLY OSTEOPOROTIC PATIENTS

作　　者：张华[1] 张健[1] 周爱国[1] 蒋电明[1] 沈洪林[1] 闫文龙[1] 

机构地区：[1]重庆医科大学附属第一医院骨科,重庆400016

出　　处：《中国修复重建外科杂志》2013年第8期980-984,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨双极股骨头置换结合张力带钢丝固定治疗高龄骨质疏松性股骨转子间骨折的疗效。方法 2004年1月-2010年12月,应用双极股骨头置换结合张力带钢丝固定治疗48例90岁以上骨质疏松性股骨转子间骨折。男15例,女33例;年龄90～99岁,平均94.1岁。均为跌倒致伤,排除病理性骨折。骨折至手术时间2～7 d,平均4.2 d。骨折按Tronzo Evans分型标准,Ⅳ型25例,Ⅲ型20例,Ⅱ型3例。均伴严重骨质疏松;均合并1种以上内科疾病,合并脊柱压缩性骨折10例。结果患者均顺利完成手术,术后2年内因内科疾病死亡6例;存活患者中39例获随访,随访时间2～7年,平均3.1年。术后出现短期精神障碍9例,可疑尿路感染2例,骶尾部褥疮1例,遗留髋部疼痛1例,大腿疼痛1例,患侧下肢深静脉血栓形成1例。术后患者切口均Ⅰ期愈合。X线片检查示骨折均愈合,随访期间无骨溶解及假体松动、下沉、断裂,未见明显异位骨化发生;均无假体翻修。术后2年Harris评分获优5例,良28例,可5例,差1例,优良率达84.6%;评分显著高于术后6周,差异有统计学意义(t=—14.79,P=0.00)。术后2年生命质量量表(SF-12)评分显著高于术后6周,差异均有统计学意义(P<0.05)。术后6周及2年VAS评分均显著低于术前,术后2年低于术后6周,差异均有统计学意义(P<0.05)。结论采用双极股骨头置换结合张力带钢丝固定治疗高龄骨质疏松性股骨转子间骨折固定牢固,允许患者早期负重锻炼、缓解疼痛,改善髋关节功能,减少卧床并发症的发生。Objective To explore the effectiveness of bipolar femoral head replacement combined with tension band wire fixation for intertrochanteric fracture in elderly osteoporotic patients. Methods Bipolar femoral head replacement combined with tension band wire fixation were used for intertrochanteric fracture in 48 elderly osteoporotic patients between January 2004 and December 2010.Of 48 patients,15 were male and 33 were female,aged 90-99 years（mean,94.1 years）.All fractures were caused by falling,and pathological fracture was excluded.It was 2-7 days（mean,4.2 days） from fracture to surgery.According to the Tronzo Evans classification,25 cases were rated as type IV,20 cases as type III,and 3 cases as type II.And all of the cases were accompanied with severe osteoporosis and accompanied by more than one medical diseases,and 10 cases had spinal compression fracture. Results All patients underwent the operation successfully.Six cases died of underlying medical illness within 2 years postoperatively.A total of 39 cases were followed up 2-7 years,averaged 3.1 years.After operation,short-term mental disorders occurred in 9 cases,suspected urinary tract infection in 2 cases,sacral rear bedsore in 1 case,hip pain in 1 case,thigh pain in 1 case,and deep vein thrombosis of affected limb in 1 case.All the incisions healed by first intension,and X-ray film showed bone union in all cases;no complications of bone osteolysis,prosthesis loosening,subsidence,rupture,and heterotopic ossification occured postoperatively.No case needed revision.According to the Harris score system,the results were excellent in 5 cases,good in 28 cases,fair in 5 cases,and poor in 1 case,with an excellent and good rate of 84.6%;the score at 2 years was significantly higher than that at 6 weeks（t= —14.79,P=0.00）.The physical health score and mental health score of SF-12 at 2 years postoperatively were significantly higher than those at 6 weeks postoperatively（P 0.05）.The visual analogue scale（VAS） scores at 6 weeks and 2 years postopera

关 键 词：股骨转子间骨折 骨质疏松 双极股骨头置换 高龄患者 

分 类 号：R687.3[医药卫生—骨科学]