张力带钢丝固定转子间四部分骨折合并髋关节疾病的全髋关节置换疗效分析  

Effects of total hip replacement combined with tension band wire fixation for intertrochanteric four-part fractures with hip diseases

作　　者：曹参[1] 杨静[1] 裴福兴[1] 沈彬[1] 周宗科[1] 康鹏德[1] 

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中国骨与关节杂志》2015年第12期965-968,共4页Chinese Journal of Bone and Joint

基　　金：卫生部2013年度卫生行业科研专项项目(201302007)

摘　　要：目的探讨全髋关节置换结合张力带钢丝固定治疗合并髋关节疾病的转子间四部分骨折的手术方法及疗效。方法纳入2005年9月至2009年9月,于华西医院骨科采用全涂层有领股骨假体行全髋关节置换治疗转子间四部分骨折合并髋关节疾病患者28例。其中,骨折前合并骨关节炎19例,合并髋关节发育不良骨关节炎4例,合并股骨头坏死2例,合并类风湿性髋关节炎3例,髋臼侧均有病变累及。骨折类型为四部分骨折,即Evans-Jensen III型。术前行疼痛视觉模拟（visual analogue scales,VAS）评分,术前、术后第2天常规X线摄片,术后1、2、3、6、12个月门诊随访,以后每年1次。每次随访均行Harris评分,VAS评分,X线摄片及体格检查。至骨折愈合前每月行X线检查1次。结果所有患者随访5-8年,平均6.3年。术后1个月Harris评分平均（69.4±7.3）分,术后半年平均（90.3±5.7）分,末次随访平均（92.4±5.6）分,21例为优,5例为良,2为可,优良率为92.8%。术后半年Harris评分高于术后1个月,差异有统计学意义（t=-47.55,P=0.00）,末次随访高于术后半年,差异有统计学意义（t=-8.87,P=0.00）。术前VAS评分平均为（6.0±1.0）分,术后1个月平均为（2.0±0.7）分,末次随访平均为（0.5±0.6）分,术后1个月低于术前,差异有统计学意义（t=28.69,P=0.00）,末次随访低于术后1个月,差异有统计学意义（t=8.80,P=0.00）。1例术后2周因摔倒致后脱位,行闭合复位,后未再发生脱位。所有患者术后第2天X线片均显示假体压配满意,骨折术后4个月均已愈合,钢丝无断裂,至末次随访假体均无松动、下沉,无假体周围骨折,无深部感染,Trendelenburg征均阴性,无明显跛行。结论全涂层有领股骨假体全髋关节置换结合张力带钢丝捆绑固定大、小转子骨折块治疗合并髋关节疾病的转子间四部分骨折可取得良好的疗效。Objective To explore the surgical technique and efficacy of total hip replacement combined with tension band wire fixation for intertrochanteric four-part fractures with hip diseases. Methods Twenty-eight cases of intertrochanteric four-part fractures and hip diseases treated with total hip replacement by a full coated, collared femoral prosthesis from September, 2005 to September, 2009 were included. Before fracture, there were 19 cases with osteoarthritis, 4 cases with osteoarthritis secondary to hip developmental dysplasia, 2 cases with femoral head necrosis, 3 cases with rheumatoid arthritis of hip, all acetabular sides had lesions involved. All were of four-part fractures （ type III in the Evans-Jensen classification ）. Preoperatively, visual analogue scales （ VAS ） were marked. X-ray films were taken before and the first day after the surgery. Follow-up evaluations were performed at1, 2, 3, 6, and 12 months, and every year thereafter. Harris score and VAS were recorded, X-ray films and physical examination were taken in each follow-up. Results All cases were followed for 5-8 years, with an average of 6.3 years. One month after the surgery, the average Harris score was 69.4±7.3. Half a year after the surgery, the average Harris score was 90.3±5.7. At the last follow-up, the average Harris score was 92.4±5.6. Results were excellent in 21 cases, good in 5 cases, fair in 2 cases, with an excellent and good rate of 92.8%. The score half a year after the surgery was significantly higher than that 1 month after the surgery with statistical significance （ t=-47.55, P=0.00 ）, and the score at the last follow-up was significantly higher than that half a year after the surgery with statistical significance （ t=-8.87, P=0.00 ）. Before the surgery, the average visual analogue scale was 6.0±1.0; 1 month after the surgery, the average scale was 2.0±0.7; at the last follow-up, the average scale was 0.5±0.6. The scale 1 month after the surgery was significantly lower than that before the surgery with s

关 键 词：髋骨折 关节成形术 置换 髋 骨折固定术 内 髋假体 

分 类 号：R687.4[医药卫生—骨科学]