人工股骨头置换结合术中股骨距重建治疗高龄不稳定型股骨转子间骨折的疗效分析  

Artificial femoral head replacement combined with intraoperative femoral calcar reconstruction to treat senile unstable intertrochanteric fractures

作　　者：储小兵[1] 金敏伟 杨扬 董睿 Chu Xiaobing;Jin Minwei;Yang Yang;Dong Rui(Department of Orthopaedics,The First Affiliated Hospital to Zhejiang University of Chinese Medicine(Zhejiang Provincial Hospital of Traditional Chinese Medicine),Hangzhou 310006,China)

机构地区：[1]浙江中医药大学附属第一医院(浙江省中医院)骨科,杭州310006

出　　处：《中华创伤骨科杂志》2021年第9期809-812,共4页Chinese Journal of Orthopaedic Trauma

基　　金：浙江省卫生健康新技术产品研发项目(2021PY055)。

摘　　要：目的探讨有领双动人工股骨头置换结合术中内侧股骨距重建治疗高龄不稳定型股骨转子间骨折的临床疗效。方法回顾性分析2014年3月至2020年2月期间浙江中医药大学附属第一医院骨科收治的28例高龄不稳定型股骨转子间骨折患者资料。男8例,女20例;年龄为75~99岁,平均81.5岁;均由跌倒的低暴力致伤。骨折Evans-Jensen分型:Ⅲ型2例,Ⅳ型5例,Ⅴ型21例;均伴有骨质疏松,骨密度T值为-4.5~-2.5。受伤至手术时间为2~6 d,平均3.8 d。术中将Corail有领股骨柄和双动人工股骨头置入,股骨转子间骨折复位后应用钛缆捆绑系统或双股缠绕钢丝捆绑固定,股骨距重建通过切取头颈骨折块的远端鸟喙状部分插入股骨柄与髓腔内侧之间嵌压打紧而实现。记录患者的手术时间、术中出血量、患髋功能及并发症发生情况等。结果本组患者的手术时间平均为62 min(50~85 min),术中出血量平均为170 mL(110~320 mL)。28例患者术后获10~71个月(平均46个月)随访。术后6个月髋关节Harris评分平均为92分(89~96分)。术后2例患者发生小腿肌间静脉血栓形成。随访期间无一例患者发生髂股深静脉血栓形成、肺栓塞、切口感染和假体深部感染等并发症。末次随访时髋关节Harris评分平均为88分(82~96分)。结论对于部分高龄不稳定型股骨转子间骨折患者,采用有领双动人工股骨头置换结合术中内侧股骨距重建治疗可以获得良好的治疗效果。Objective To evaluate collared and bipolar hemiarthroplasty combined with medial femoral calcar reconstruction in the treatment of senile patients with osteoporotic unstable intertrochanteric fracture.Methods The data of 28 senile patients with unstable femoral intertrochanteric fracture were retrospectively analyzed who had been admitted to Department of Orthopedics,The First Affiliated Hospital to Zhejiang University of Chinese Medicine from March 2014 to February 2020.They were 8 males and 20 females,aged from 75 to 99 years(average,81.5 years).All the fractures were low violence injuries due to falls.By the Evans-Jensen classification,there were 2 cases of typeⅢ,5 cases of typeⅣand 21 cases of typeⅤ.All patients were osteoporotic,with a BMD T-score ranging from-4.5 to-2.0.Surgery was performed 2 to 6 days after injury(3.8 days on average).Corail collared femoral stems and bipolar ball heads produced by DePuy company were selected for implantation during surgery.Their fractures were reduced and fixated by titanium wire bundling system or bifilar winding wire bundles.The femoral calcar reconstruction was accomplished by inserting the beak-shaped distal part of the head-neck fracture fragment into the femoral medullary cavity together with the medial side of the stem just under the collar and impacting it to a tight position.Results The average operation time for this group of patients was 62 min(from 50 to 85 min)and the average intraoperative blood loss 170 mL(from 110 to 320 mL).All the 28 patients were followed up for 10 to 71 months(average,46 months).Their Harris hip scores averaged 92 points(from 89 to 96 points)at 6 months after operation.Two patients developed intermuscular venous thrombosis in the calf after operation.During follow-up,none of the patients had such complications as deep iliac femoral vein thrombosis,pulmonary embolism,incision infection,or deep prosthesis infection.At the last follow-up,their Harris hip scores averaged 88 points(from 82 to 96 points).Conclusion For some senile pat

关 键 词：髋骨折 关节成形术 置换 髋 老年人 股骨距 

分 类 号：R687.3[医药卫生—骨科学]