骨水泥型人工股骨头置换与股骨近端防旋髓内钉置入治疗老年脑梗死患者偏瘫侧股骨转子间骨折的比较  

Curative effects of cemented hemiarthroplasty versus proximal femoral nail anti-rotation for treatment of intertrochanteric fractures of cerebral infarction hemiplegia side in older adults

作　　者：万乾 杨小华[1] 张擎柱[1] 冯震[1] 谷锐[1] Wan Qian;Yang Xiaohua;Zhang Qingzhu;Feng Zhen;Gu Rui(Department of Traumatic Orthopedics,Affiliated Hospital of Chengde Medical University,Chengde 067000,Hebei Province,China)

机构地区：[1]承德医学院附属医院创伤骨科,河北省承德市067000

出　　处：《中国组织工程研究》2018年第35期5590-5595,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:骨水泥型人工股骨头置换与股骨近端防旋髓内钉治疗老年股骨转子间骨折均可取得较好的临床疗效,但老年脑梗死偏瘫侧股骨转子间骨折属于特殊类型,针对其手术治疗方案,目前仍存在较多争议。目的:比较骨水泥型人工股骨头置换与股骨近端防旋髓内钉置入治疗老年脑梗死偏瘫侧股骨转子间骨折的临床疗效。方法:对2013年10月至2017年1月承德医学院附属医院收治的61例老年脑梗死偏瘫侧股骨转子间骨折患者的临床资料进行回顾性分析,依据治疗方法不同分为2组,置换组29例行骨水泥型人工股骨头置换治疗,股骨近端防旋髓内钉组32例行股骨近端防旋髓内钉固定治疗。记录并比较2组患者的手术时间、术中出血量、手术前后血红蛋白差值、术后卧床时间、围手术期并发症发生率,以及术后半年和1年髋关节Harris评分。结果与结论:(1)与股骨近端防旋髓内钉组相比,置换组的手术时间延长,术中出血量增大,术后半年髋关节Harris评分升高,差异均有显著性意义(P <0.05);(2)但2组手术前后血红蛋白差值、术后卧床时间、围手术期并发症发生率及术后1年髋关节Harris评分相比,差异均无显著性意义(P> 0.05);(3)结果说明,与股骨近端防旋髓内钉相比,骨水泥型人工股骨头置换治疗老年脑梗死偏瘫侧股骨转子间骨折短期内髋关节功能恢复更好,但手术时间更长,术中出血量更大;而2种治疗方式在手术前后血红蛋白差值、术后卧床时间、围手术期并发症发生率以及远期髋关节功能恢复等方面无明显差别。BACKGROUND:Cemented hemiarthroplasty and proximal femoral nail anti-rotation in the treatment of senior intertrochanteric fractures both can achieve good clinical curative efficacy,but intertrochanteric fractures of senior cerebral infarction hemiplegia side is a special type.For the surgical treatment program,there are still many disputes.OBJECTIVE:To compare the clinical outcomes between cemented hemiarthroplasty and proximal femoral nail anti-rotation placement for the patients with intertrochanteric fractures of senior cerebral infarction hemiplegia side.METHODS:A retrospective analysis of 61 patients with intertrochanteric fractures of senior cerebral infarction hemiplegia side admitted in Affiliated Hospital of Chengde Medical University from October 2013 to January 2017 was performed.The subjects were divided into two groups according to different treatment methods:cemented hemiarthroplasty group(n=29)and proximal femoral nail anti-rotation group(n=32).The operation time,intraoperative blood loss,hemoglobin difference before and after operation,postoperative bed time,incidence of perioperative complications,and Harris scores at 6 months and 1 year postoperatively were compared between groups.RESULTS AND CONCLUSION:(1)Compared with the proximal femoral nail anti-rotation group,the operation time was significantly lengthened,intraoperative blood loss was significantly increased,and the Harris scores at 6 months postoperatively were significantly increased in the cemented hemiarthroplasty group(P<0.05).(2)The hemoglobin difference before and after operation,postoperative bed time,incidence of perioperative complications,and Harris scores at 1 year showed no significant differences between two groups(P>0.05).(3)These results indicate that compared with proximal femoral nail anti-rotation,cemented hemiarthroplasty for the treatment of the patients with intertrochanteric fractures of elderly cerebral infarction hemiplegia side has a better recovery of hip function in a short time,but its operation time is longer

关 键 词：股骨转子间骨折 脑梗死 偏瘫 人工股骨头置换 股骨近端防旋髓内钉 骨科植入物 髋骨折 脑梗塞 关节成形术 置换 组织工程 

分 类 号：R459.9[医药卫生—治疗学]