| 髋关节置换术治疗老年股骨转子间骨折内固定失败的中期随访 |
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投稿时间：2017-02-20
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| 作者 | Author | 单位 | Address | E-Mail |
| 孙启才 |
SUN Qi-cai |
浙江医院, 浙江 杭州 310013 |
Zhejiang Hospital, Hangzhou 310013, Zhejiang, China |
sunqicai20718170@126.com |
| 茹选良 |
RU Xuan-liang |
浙江医院, 浙江 杭州 310013 |
Zhejiang Hospital, Hangzhou 310013, Zhejiang, China |
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| 钱志钢 |
QIAN Zhi-gang |
浙江医院, 浙江 杭州 310013 |
Zhejiang Hospital, Hangzhou 310013, Zhejiang, China |
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| 吴立东 |
WU Li-dong |
浙江大学医学院附属第二医院, 浙江 杭州 310009 |
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| 严世贵 |
YAN Shi-gui |
浙江大学医学院附属第二医院, 浙江 杭州 310009 |
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| 王祥华 |
WANG Xiang-hua |
浙江大学医学院附属第二医院, 浙江 杭州 310009 |
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| 期刊信息：《中国骨伤》2017年，第30卷，第7期，第591-596页 |
| DOI：10.3969/j.issn.1003-0034.2017.07.002 |
| 基金项目:浙江省医药卫生一般研究计划项目（编号：2014KYB010，2012KYB007）；浙江省中医药科技计划项目（编号：2017ZB003） |
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中文摘要:
目的：回顾性分析人工髋关节置换治疗老年股骨转子间骨折内固定失败的中期疗效。
方法：收集2008年12月至2011年12月收治的32例老年股骨转子间骨折内固定失败病例（男17例，女15例），采取髋关节置换术（total hip arthroplasty，THA）治疗，其中4例死亡病例排除在外，28例纳入研究，年龄69~83岁，平均75岁；内固定手术与髋关节置换之间相隔8~72个月。其中EvansⅠ型6例，Ⅱ型11例，Ⅲ型9例，Ⅳ型2例。手术前显示侧板断裂9例，头钉切割股骨头颈切出15例，螺丝松动4例。采用Harris评分比较患者术前和末次随访髋关节功能变化，并随访术后影像学结果（X线）、血沉等指标。
结果：28例获得完整随访，随访时间4~7年，平均5.3年。患者疼痛均较术前明显减轻或消失，髋关节功能明显改善，2例活动后有中度疼痛，4例活动后出现轻微疼痛。末次随访时，19例恢复自由行走，8例需要手杖帮助下行走，1例需要助行器帮助下行走。Harris评分由术前34.9±2.4提高至术后末次随访的83.4±5.7；末次随访时优15例，良10例，可2例，差1例。X线检查未见假体松动及下沉断裂。
结论：对于股骨转子间骨折内固定失败的高龄患者，行挽救性THA能有效改善髋关节功能，提高患者的生活质量，并且中期随访结果较好。 |
| 【关键词】股骨骨折 骨折固定术,内 关节成形术,置换,髋 |
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| Mid-term follow-up study of hip arthroplasty for internal fixation failure of femoral intertrochanteric fractures in the elderly |
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ABSTRACT
Objective: To retrospective analysis the mid-term follow-up effect of hip joint replacement in elderly patients with failure of intertrochanteric fractures of the hip joint internal fixation.
Methods: From December 2008 to December 2011,32 elderly patients underwent arthroplasty after intertrochanteric fracture fixation failure,of which,4 death cases were excluded from the study,and the remaining 28 cases were in the study group. The age of patients ranged from 69 to 83 years old with a mean of 75 years old. The time from the internal fixation to the hip replacement were 8 to 72 months. Among them,6 patients were Evans Ⅰ type,11 patients were Evans Ⅱ type,9 patients were Evans Ⅲ type,and 2 patients were Evans IV type. Nine cases showed fracture of the lateral plate before operation,while 15 cases were femoral head screw cut-out and 4 cases were screw loosening. Harris score was used to compare the changes of hip function before operation with the final follow-up. Imaging results(X-ray) and erythrocyte sedimentation rate(ESR) were performed during the follow-up.
Results: All patients were followed up from 4 to 7 years with an average of 5.3 years. Pain was significantly reduced or disappeared in patients compared with pre-operation. And hip function was significantly improved. Two cases had moderate pain after the physical activity and 4 cases had mild pain after the physical activity. At the final follow-up,19 patients resumed free walking,8 patients required walking with walking sticks,and 1 patient needed walking aid. The Harris scores improved from preoperative 34.9±2.4 to 83.4±5.7 at the final follow-up,among them,15 cases were classified as excellent,10 as good,2 as fair,and 1 as poor. X-ray examination showed no prosthesis loosening and sinking fracture.
Conclusion: Salvage THA surgery could improve the hip function and the quality of life for old patients with intertrochanteric fracture fixation failure,and the middle-term follow-up results support that. |
| KEY WORDS KEYWORDS Femoral fractures Fracture fixation,internal Arthroplasty,replacement,hip |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 孙启才,茹选良,钱志钢,吴立东,严世贵,王祥华.髋关节置换术治疗老年股骨转子间骨折内固定失败的中期随访[J].中国骨伤,2017,30(7):591~596 |
| 英文格式: | SUN Qi-cai,RU Xuan-liang,QIAN Zhi-gang,WU Li-dong,YAN Shi-gui,WANG Xiang-hua.Mid-term follow-up study of hip arthroplasty for internal fixation failure of femoral intertrochanteric fractures in the elderly[J].zhongguo gu shang / China J Orthop Trauma ,2017,30(7):591~596 |
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