人工髋关节置换术治疗未愈合的陈旧性转子间骨折的临床特点及手术治疗策略  

Clinical features and surgical treatment strategies of hip arthroplasty for unhealed old femoral intertrochanteric fractures

作　　者：夏青[1] 刘传文 夏玉城 王会杨 郭金泉 XIA Qing;LIU Chuan-wen;XIA Yu-cheng;WANG Hui-yang;GUO Jin-quan(Department of Orthopaedics,Dezhou Hospital of Shandong University Qilu Hospital,Dezhou 253032,Shandong,China)

机构地区：[1]山东大学齐鲁医院德州医院关节外科,山东德州253032

出　　处：《中国骨伤》2025年第2期188-194,共7页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨人工髋关节置换治疗未愈合陈旧性股骨转子间骨折的手术方法及其临床疗效。方法:选取2013年2月至2023年2月未经手术的陈旧性股骨转子间骨折未愈合患者15例采用人工髋关节置换,男9例,女6例,年龄71~82岁,11例发生发现下肢深静脉血栓(deep vein thrombosis,DVT),其中接受下腔静脉滤器植入9例。记录患者手术时间、术中失血量、输血量、术后血红蛋白含量、手术相关并发症以及髋关节屈曲、外展活动度。采用视觉模拟评分表(visual analogue scale,VAS)评价髋关节疼痛程度。采用Harris评分来评价临床疗效。结果:所有患者获得随访,时间3~12个月,术中出血量200~400 ml,术中输血0~400 ml,手术时间40~90 min。15例患者术后均有不同程度的贫血,术后3 d血红蛋白72~97 g·L^(-1),术后输血量0~400 ml。所有患者无假体周围感染、切口愈合不良、下肢深静脉血栓形成、脑梗死等心脑血管意外发生,但术后早期发生谵妄1例,于术后4~5 d谵妄消失,在末次随访时均无再翻修。髋关节VAS术前6~7分,末次随访2~4分;髋关节Harris评分术前2~13分,末次随访73~84分。结论:未经手术的陈旧性股骨转子间骨折未愈合有其显著的临床和影像学特点,远端固定型股骨假体的人工髋关节置换术,具有操作相对简单,固定牢固、手术相对安全和相对满意的临床疗效的优点。Objective To explore the surgical method and clinical efficacy of hip arthroplasty in the treatment of old non-union femoral intertrochanteric fractures.Methods Fifteen unoperated patients suffering from old non-union femoral intertrochanteric fractures from Feburary 2013 to Feburary 2023 were treated with hip arthroplasty including 9 males and 6 females,aged 71 to 82 years old.Eleven cases detected deep venous thrombosis(DVT),9 cases received lower vena cava filter implantation.The operation time,intraoperative blood loss,intraoperative and postoperative blood transfusion,postoperative hemoglobin content,procedure-related complications,and the range of motion of hip flexion,abduction motion were recorded.The degree of hip pain was evaluated using a visual analogue scale(VAS).The hip Harris scores were used to evaluated the clinical efficacy.Results All patients were followed up for 3 to 12 months.The intraoperative blood loss was 200 to 400 ml,intraoperative blood transfusion was 0 to 400 ml,and the operation time was 40 to 90 min.All 15 patients had different degrees of anemia after surgery,the 3 days postoperative hemoglobin was 72 to 97 g·L^(-1),and the postoperative transfusion volume was 0 to 400 ml.All patients had no periprosthetic infection,poor incision healing,lower limb deep vein thrombosis,and cerebral infarction.One case occurred in the early postoperative period,which disappeared from 4 to 5 days after operation,and there was no further revision at the last follow-up.The VAS was 6 to 7 points before operation and 2 to 4 points at latest follow-up;the hip Harris score was 2 to 13 points before operation and 73 to 84 points at latest follow-up.Conclusion The unoperated patients of old non-union femoral intertrochanteric fractures had significant clinical and imaging characteristics.Hip arthroplasty combined with or without femoral calcar reconstruction in the treatment of old non-union femoral intertrochanteric fractures had the advantages of relatively simple manipulation,rigid fixation,relatively

关 键 词：股骨转子间骨折 陈旧性骨折 髋关节置换术 骨质疏松 

分 类 号：R683.42[医药卫生—骨科学]