高龄骨质疏松性转子间骨折和股骨颈骨折的半髋置换疗效比较  

Comparison on clinical efficacy of bipolar femoral head replacement for intertrochanteric fracture and femoral neck fracture in eldly and osteoporotic patients

作　　者：张华[1] 张健[1] 闫文龙[1] 张圣雨[1] 李哲学[1] 杨庆[1] 张科[1] 张艳芳[1] 帖红涛[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：《重庆医科大学学报》2014年第12期1784-1789,共6页Journal of Chongqing Medical University

摘　　要：目的：比较半髋（双极股骨头）置换治疗高龄骨质疏松性股骨转子间骨折（结合克氏针张力带固定）和股骨颈骨折的疗效是否相似。方法：2004年1月至2010年12月,应用双极股骨头置换结合克氏针张力带固定治疗高龄骨质疏松性股骨转子间骨折132例（女91例,男41例,手术时年龄为75~99岁,平均年龄80.2岁,按Tronzo Evans分型,Ⅳ型98例,Ⅲ型23型,Ⅱ型11例）和单纯半髋置换治疗股骨颈骨折135例（女87例,男48例,手术时年龄为74~95岁,平均年龄79.5岁,按Garden分型,Ⅳ型52例,Ⅲ型78型,Ⅱ型5例）。按世界卫生组织对于骨质疏松的诊断标准,所有患者均为严重骨质疏松。对手术时间、出血量、下地时间、住院时间、围手术期和术后长期随访并发症、Harris评分和SF-12量表评分结果进行了比较研究。结果：术后手术切口均一期愈合。转子间骨折组和股骨颈骨折组分别有112例和118例患者获得随访,时间2~5年,平均随访3.1年。转子间骨折组患者手术时间较股骨颈骨折组长（Z=13.003,P=0.000）,余差异未见明显统计学意义（P〉0.05）。转子间骨折组术后1月内死亡2例,股骨颈骨折组3例,但差异无统计学意义（P〉0.05）,其他并发症统计差异亦无意义（P〉0.05）,2组术后1.5月和术后2年髋关节功能Harris评分和SF-12评分差异无统计学意义（P〉0.05）。结论：应用双极股骨头置换结合克氏针张力带固定治疗高龄骨质疏松性股骨转子间骨折是有效的方法之一,可以收到和髋关节置换治疗老年骨质疏松性股骨颈骨折相似的效果,值得临床推广。Objective：To compare the clinical efficacy of bipolar femoral head replacement for intertrochanteric fracture （accompanied Kirschner wires tension band fixation） and femoral neck fracture in eldly and osteoporotic patients. Methods：Bipolar femoral head re- placement combined with Kirschner wires tension band fixation was applied for 132 elderly patients with intearochanteric fracture and sin- gle bipolar femoral head replacement was used for 135 elderly patients with femoral neck fracture from January 2004 to December 2010. All patients were diagnosed as severe osteoporosis according to the WHO classification.The operating time, blood loss, post-operative am- bulation time, hospital duration, complication during perioperative period and follow-up, Harris score and SF-12 score were compared. Results：All the incisions healed by the first intension postoperatively. A total of 112 cases in intertrochanteric fracture group and 118 cases in femoral neck fracture group were followed-up for 2-5 years successfully, averaged 3.1 years. The operating time of in- tertrochanteric fracture group was significantly longer than that of femoral neck fracture group（Z=13.003,P=-0.000） and there was no difference in the other indicators above between two groups（P〉O.05）. Two patients in intertrochanteric fracture group and 3 patients in femoral neck fracture group died at 1 month postoperatively;but there was no statistical difference in complication and death inci- dences between two groups（P〉O.05）. There was no significant difference in Harris score and SF-12 score at 1.5 months and 2 years postoperatively（P〉0.05）. Conclusion：Bipolar femoral head replacement combined with Kirschner wires tension band fixation is effec- tive for intertrochanteric fracture in eldly and osteoporotic patients;its efficacy is similar to that of hip replacement for femoral neck fracture; therefore deserves clinical expansion.

关 键 词：股骨转子间骨折 骨质疏松 双极股骨头置换 克氏针张力带 

分 类 号：R683.32[医药卫生—骨科学]