人工股骨头置换术对超高龄不稳定型股骨转子间骨折伴骨质疏松症治疗的近期临床疗效  

Analysis on clinical efficacy of artificial femoral head replacement for unstable intertrochanteric fractures in elderly patients with osteoporosis

作　　者：杨朝旭[1] 田志[1] 邢栋[1] 魏景超[1] 李旭明[1] 李文毅[1] Yang Zhaoxu;Tian Zhi;Xing Dong;Wei Jingchao;Li Xuming;Li Wenyi(Department of Orthopaedics,Hebei People’s Hospital,Shijiazhuang 050051,China)

机构地区：[1]河北省人民医院骨科,石家庄050051

出　　处：《创伤外科杂志》2021年第1期33-36,共4页Journal of Traumatic Surgery

基　　金：河北省卫健委指令性课题(20150120)。

摘　　要：目的探讨人工股骨头置换术对超高龄不稳定型股骨转子间骨折伴骨质疏松症的临床效果。方法回顾性分析2018年1月—2019年7月河北省人民医院骨科收治超高龄(≥90岁)不稳定型股骨转子间骨折伴骨质疏松症患者96例,男性42例,女性54例;年龄91~106岁,平均95.8岁,均为摔伤导致骨折。根据患者术式不同(患者自愿选择)分为髓内钉内固定组与股骨头置换组,各48例,髓内钉内固定组行防旋型股骨近端髓内钉治疗,股骨头置换组行人工股骨头置换治疗。髓内钉内固定组男性22例,女性26例;年龄91~106岁,平均96.2岁。股骨头置换组男性20例,女性28例;年龄92~105岁,平均95.6岁。观察两组患者手术时间、术中出血量、下地负重时间、术后3个月、1年Harris评分优良率以及并发症发生情况。结果髓内钉内固定组手术时间(67.2±9.3)min短于股骨头置换组(90.6±10.4)min,差异有统计学意义;术中出血量(121.8±31.4)mL少于股骨头置换组(130.7±40.6)mL,但差异无统计学意义(P>0.05),髓内钉内固定组下地负重行走时间(12.5±2.0)d长于股骨头置换组(5.6±2.1)d,差异有统计学意义(P<0.05);术后3个月、1年随访,股骨头置换组Harris评分优良率分别为85%和92%,髓内钉固定组65%和71%,股骨头置换组优于髓内钉固定组,差异有统计学意义(P<0.05)。髓内钉内固定组患者发生术后并发症4例,分别为泌尿系感染2例、患肢深静脉血栓形成2例;股骨头置换组2例,均为坠积性肺炎,差异无统计学意义(P>0.05)。结论应用人工股骨头置换治疗≥90岁的超高龄不稳定型股骨转子间骨折伴骨质疏松症患者,其近期临床效果优于防旋型股骨近端髓内钉治疗,值得临床推广应用。Objective To investigate the clinical efficacy of artificial femoral head replacement for unstable intertrochanteric fractures in elderly patients with osteoporosis.Methods Totally 96 elderly patients with unstable intertrochanteric fractures and osteoporosis admitted to Department of Orthopaedics of our hospital from Jan.2018 to Jul.2019 were included in this study.There were 42 males and 54 females with an average age of 95.8 years(range,91-106 years).All patients suffered from fracture due to falling.They were divided into the internal fixation group and the replacement group according to surgical methods with 48 cases in each group.The patients in internal fixation group were provided with proximal femoral nail internal fixation treatment[22 males and 26 females with an average age of 96.2 years(range,91-106 years)]and those in replacement group were provided with artificial femoral head replacement treatment[20 males and 28 females with an average age of 95.6 years(range,92-105 years)].Operation time,intraoperative blood loss,weight-bearing time,Harris score,excellent and good rate at postoperative 3 months and 1 year,and complications were compared between the two groups.Results There was statistically significant difference in the surgery time between two groups[(67.2±9.3)minutes vs.(90.6±10.4)minutes,P>0.05],as well as the walking time on the ground with load[(12.5±2.0)days vs.(5.6±2.1)days,both P<0.05].There was no difference in amount of intraoperative bleeding[(121.8±31.4)mL vs.(130.7±40.6)mL],P>0.05.At 3 months and 1 year follow-up,the excellent and good rate of Harris score in the femoral head replacement group was 85%and 92%,respectively,and those of the intramedullary nail fixation group was 65%and 71%,respectively.The difference was statistically significant(P<0.05).In the internal fixation group,four cases had postoperative complications:two cases of urinary infection and two cases of formation of deep vein thrombosis in the injured limb.In the replacement group,hypostatic pneumonia occurre

关 键 词：股骨转子间骨折 骨质疏松症 髓内钉 置换术 超高龄 

分 类 号：R683.42[医药卫生—骨科学]