加长柄人工股骨头置换术联合个性化内固定治疗高龄不稳定股骨粗隆间骨折疗效观察  

Clinical efficacy analysis of lengthened stem artificial femoral head replacement combined with personalized internal fixation in treatment of unstable femoral intertrochanteric fractures in elderly patients

作　　者：白亮[1] 孟晓琳[1] 张慧[1] 王叶密 曾庆亮 周梅 张雷 庄全魁[1] BAI Liang;MENG Xiaolin;ZHANG Hui;WANG Yemi;ZENG Qingliang;ZHOU Mei;ZHANG Lei;ZHUANG Quankui(Department of Orthopedics,NO.2 People’s Hospital of Fuyang City,Fuyang,Anhui 236000,China)

机构地区：[1]阜阳市第二人民医院骨科,安徽236000

出　　处：《中国骨与关节损伤杂志》2024年第10期1009-1012,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的观察骨水泥型加长柄人工股骨头置换术联合个性化内固定治疗高龄不稳定股骨粗隆间骨折的临床疗效。方法回顾性分析自2018-07—2021-07采用骨水泥型加长柄人工股骨头置换术治疗的82例高龄不稳定股骨粗隆间骨折,术中在骨水泥凝固后轻微活动患侧髋关节,根据活动后股骨大粗隆及股骨距骨块是否移位进行个性化内固定。仅股骨大粗隆骨块移位时,处理粉碎骨折块,用张力带、钢丝或钛缆固定股骨大粗隆。仅股骨距骨块移位时,用钢丝或钛缆将股骨大粗隆及股骨距捆扎,收紧钢丝或钛缆固定。若股骨大粗隆和股骨距骨块均移位,先用张力带、钢丝或钛缆固定股骨大粗隆,再用钢丝或钛缆环绕固定股骨大粗隆和股骨距。结果2例术后因基础疾病加重而死亡,其余80例获得完整随访,随访时间6~18个月,平均13.5个月。7例术后出现呼吸系统感染,经抗感染、化痰、翻身拍背治疗后痊愈。4例股骨小粗隆处骨折不愈合,但是行走功能正常,未进行特殊处理。2例出现切口脂肪液化,换药后切口愈合良好。1例术后外伤导致股骨大粗隆骨折分离移位,再次手术重新捆绑固定后骨折愈合。末次随访时摄髋部X线片显示人工股骨头假体在位,骨水泥填充良好,股骨大粗隆骨折均愈合。末次随访时髋关节功能Harris评分为75~92分,平均89.2分。结论高龄不稳定股骨粗隆间骨折采用骨水泥型加长柄人工股骨头置换术治疗可以降低卧床并发症发生率,同时避免了骨折内固定失败风险;联合股骨大粗隆和股骨距骨块个性化内固定可以为股骨假体提供良好的稳定性,促进髋关节功能恢复良好。Objective To observe the clinical efficacy of cemented extended stem artificial femoral head replacement combined with personalized internal fixation in the treatment of unstable femoral intertrochanteric fractures in the elderly.Methods A ret⁃rospective analysis of 82 cases of unstable femoral intertrochanteric fractures in the elderly treated with cemented extended stem artificial femoral head replacement from July 2018 to July 2021 was conducted.During the operation,the affected hip joint was slightly mobilized after the bone cement solidified.The personalized fixation was performed depending on whether the femoral greater trochanter and femoral calcar mass were displaced after activation.If only the femoral greater trochanter was displaced,the comminuted fracture was treated,and the femoral greater trochanter was fixed with tension band,steel wire or titanium ca⁃ble.If only the femoral calcar block was displaced,the greater trochanter and femoral calcar was tied with steel wire or titanium cable,and the steel wire or titanium cable was tightened to fix it.If both femoral greater trochanter and femoral calcar were dis⁃placed,the femoral greater trochanter was fixed with tension band,steel wire or titanium cable,and then femoral greater trochan⁃ter and femoral calcar were fixed with steel wire or titanium cable.Results Two cases died due to aggravation of underlying diseases after operation,and the remaining 80 cases were completely followed up for 6-18 months,with an average of 13.5 months.Seven cases had respiratory system infection after operation,and they were cured after anti-infection,phlegm reduction,turning over and patting the back.Four cases had non-union of femoral trochanter fracture,but the walking function was normal,and no special treatment was given.The incision fat liquefaction occurred in 2 cases,and the incision healed well after dressing change.One case had postoperative trauma caused the separation and displacement of femoral trochanter fracture,and the frac⁃ture healed after re-o

关 键 词：不稳定股骨粗隆间骨折 人工股骨头置换术 骨水泥型加长柄 股骨距 个性化内固定 高龄 

分 类 号：R687.42[医药卫生—骨科学]