髋关节置换治疗高龄不稳定型股骨转子间骨折  

The hip arthroplasty foRtreatment of senile patients with unstable femoral intertrochanteric fracture

作　　者：吴明凡 江淮[1] 郑权 陈学周 邵松[1] 孙良业[1] 谢威[1] WU Ming-fan;JIANG Huai;ZHENG Quan;CHEN Xue-zhou;SHAO Song;SUN Liang-ye;XIE Wei(Dept of Orthopaedics,the People′s Hospital of Lu′an City,Lu′an Hospital Affiliated to Anhui Medical University,Lu′an,Anhui 237000,China)

机构地区：[1]六安市人民医院(安徽医科大学附属六安医院)骨科,安徽六安237000

出　　处：《临床骨科杂志》2022年第4期482-486,共5页Journal of Clinical Orthopaedics

摘　　要：目的总结髋关节置换治疗高龄不稳定型股骨转子间骨折的疗效。方法采用全髋或半髋关节置换治疗38例高龄不稳定型股骨转子间骨折患者,术中用钢丝克氏针固定大转子。记录手术情况,采用大转子高度(GTH)评估术后骨折复位情况。末次随访时,采用Koval评分评估患者行走能力,采用Harris评分评价髋关节功能恢复情况,采用MRC分级评估髋外展肌力。结果38例患者中,3例采用全髋关节置换,35例采用半髋关节置换;非骨水泥全涂层柄31例,骨水泥柄7例。32例患者获得随访,时间12~34(20.4±5.9)个月;6例失访。术后患侧GTH为-8.9~4.7(-1.1±4.6)mm,健侧GTH为-4.6~4.3(0.3±3.2)mm,差异有统计学意义(P<0.01)。术后12个月摄X线片复查,30例骨折愈合,2例未见骨折断端连接及骨痂形成,但纤维愈合,并未影响外展肌力或行走能力。行走能力Koval评分末次随访时与术前比较差异有统计学意义(P<0.01)。末次随访时髋关节Harris评分69~93(83.1±5.5)分,髋外展肌力MRC分级为3~5(4.2±0.8)级。结论髋关节置换治疗高龄不稳定型股骨转子间骨折,术中采用钢丝克氏针固定大转子,重建了臀中肌的外展机制,术后疗效满意。Objective To summarize the curative effect of hip arthroplasty foRsenile patients with unstable femoral intertrochanteric fracture.Methods The 38 senile osteoporosis patients who suffered from unstable femoral intertrochanteric fractures,were treated by total hip arthroplasty(THA)oRhemiarthroplasty of the hip,using steel wire KirschneRwire foRfixation of the greateRtrochanteRduring the operation.The operative situation was recorded,and the greateRtrochanteRheight(GTH)was used to assess the postoperative fracture reduction effect.At the last follow-up,the patient′s walking ability was assessed with Koval score,and Harris score was used to evaluate the hip function recovery,the hip abductoRmuscle strength was assessed with the MRC grade.Results Among the 38 patients,3 cases underwent THA,and 35 cases were performed with hemiarthroplasty of the hip.There were 31 cases with uncemented fully coated stems and 7 cases with cemented stems.Thirty-two patients were followed up foR12~34(20.4±5.9)months,6 cases were lost to follow-up.Postoperative imaging showed that the GTH was-8.9~4.7(-1.1±4.6)mm,-4.6~4.3(0.3±3.2)mm in the affected side and healthy side,respectively.The difference was statistically significant(P<0.01).At 12 months afteRthe operation,X-ray reexamination showed that 30 cases were healed;and in 2 cases,there was no fracture end connection oRcallus formation,but fibeRhealing did not affect hip abductoRmuscle strength oRwalking ability.The Koval score of waling ability had difference between the last follow-up and the preoperation(P<0.01).At the last follow-up,Harris hip scores were 69~93(83.1±5.5)points,and MRC grade of abductoRmuscle strength was 3~5(4.2±0.8)grade.Conclusions Hip arthroplasty foRunstable femoral intertrochanteric fracture of senile osteoporosis patients,using steel wire and KirschneRwire foRfixation of the greateRtrochanteRduring the operation,which can reconstruct the abductive mechanism of gluteus medius muscle,with satisfactory effect.

关 键 词：不稳定型股骨转子间骨折 骨质疏松 钢丝张力带 髋关节置换 老年人 

分 类 号：R683.42[医药卫生—骨科学] R687.4[医药卫生—外科学]