生物型人工髋关节置换术对高龄不稳定股骨转子间粉碎性骨折的疗效及对骨密度水平的影响  

Effect of Bio-artificial Hip Replacement on the Treatment of Unstable Intertrochanteric Comminuted Fracture in Elderly Patients and on the Bone Mineral Density

作　　者：张平方 王鑫 马蒲阳 张辉[1] 何杨[1] 王建民[1] 董红[1] 赵宇宙[1] Zhang Pingfang;Wang Xin;Ma Puyang(General Hospital of North China Petroleum Administration,Renqiu,Hebei 062552,China)

机构地区：[1]华北石油管理局总医院骨一科门诊办公室

出　　处：《四川医学》2019年第11期1138-1141,共4页Sichuan Medical Journal

摘　　要：目的探讨生物型加长柄人工髋关节置换术治疗高龄不稳定股骨转子间粉碎性骨折的效果及对患者骨密度的影响。方法选取我院2014年3月至2017年3月收治的98例高龄不稳定股骨转子间粉碎性骨折患者,其中49例采用骨水泥假体置换术(骨水泥组)、另外49例采用生物型假体置换术(生物组),对比两组患者的手术时间、出血量、术后引流量、术后输血量、术后下床活动时间、术后不同时间点的Harris功能评分、股骨假体周围骨密度(BDM)变化。结果骨髓泥组和生物组的手术时间、出血量、术后输血量、术后下床活动时间差异无统计学意义(P>0.05);骨髓泥组的术后引流量低于生物组,差异有统计学意义(P<0.05)。术后12个月,骨髓泥组和生物组的髋关节Harris评分差异无统计学意义(P>0.05);术后3个月、术后6个月,骨髓泥组的髋关节Harris评分高于生物组,差异有统计学意义(P<0.05)。术后1周、术后12个月,骨髓泥组和生物组的股骨假体周围Gruen 7个分区BDM测定值差异无统计学意义(P>0.05);与本组术后1周比较,骨髓泥组和生物组患者股骨假体周围Gruen分区第1区、第6区、第7区的BDM值均显著的降低,差异有统计学意义(P<0.05)。结论生物型加长柄人工髋关节置换术治疗高龄不稳定股骨转子间粉碎性骨折的效果与骨水泥假体相近,但是术后髋关节功能恢复稍慢,术后患者假体周围存在一定的骨密度丢失,这可能导致术后假体松动的发生。Objective To investigate the effect of bio-artificial hip replacement on the treatment of unstable intertrochanteric comminuted fractures in elderly patients and on the bone mineral density.Methods 98 elderly patients with unstable intertrochanteric comminuted fractures from March 2014 to March 2017 were enrolled in our hospital.49 patients underwent bone cemented prosthesis replacement(bone cement group)and 49 patients were treated with biological prosthesis replacement(biological group).The operation time,bleeding volume,postoperative drainage and blood transfusion volume,time of getting out of bed,Harris function score and bone mineral density(BDM)around femoral prosthesis were compared.Results There were no significant difference in the operation time,bleeding volume,postoperative blood transfusion volume and time of getting out of bed between bone cement group and biological group(P>0.05).Compare to biological group,the postoperative drainage volume of the bone cement group was lower with significant difference(P<0.05).At 12 months after operation,there was no significant difference in hip Harris score between bone cement group and biological group(P>0.05).The hip joint Harris score of the bone cement group was higher than that in the biologic group at 3 and 6 months after operation(P<0.05).There was no significant difference in BDM between two groups in the Gruen 7 substrate at 1 week after surgery(P>0.05).Compared with the group at 1 week after surgery,the BDM values of the first,sixth and seventh regions of the Gruen sub-region around the femoral prosthesis were significantly decreased in the two groups(P<0.05).Conclusion The effect of bio-artificial hip replacement on the treatment of unstable intertrochanteric comminuted fractures in elderly patients is similar to that of bone cemented prostheses,but the recovery of hip joint function is slightly slower.There is a certain bone density around the prosthesis which may lead to postoperative prosthesis loosening.

关 键 词：生物型加长柄人工髋关节 高龄 不稳定股骨转子间粉碎性骨折 骨密度 

分 类 号：R687.4[医药卫生—骨科学]