| 生物型加长柄关节置换治疗高龄股骨转子间不稳定骨折的中期疗效分析 |
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投稿时间：2019-07-17
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| 作者 | Author | 单位 | Address | E-Mail |
| 邓闽军 |
DENG Min-jun |
湖州市第一人民医院骨科, 浙江 湖州 313000 |
Department of Orthopaedics, the First People's Hospital of Huzhou, Huzhou 313000, Zhejiang, China |
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| 孙振国 |
SUN Zhen-guo |
湖州市第一人民医院骨科, 浙江 湖州 313000 |
Department of Orthopaedics, the First People's Hospital of Huzhou, Huzhou 313000, Zhejiang, China |
775200057@qq.com |
| 闵继康 |
MIN Ji-kang |
湖州市第一人民医院骨科, 浙江 湖州 313000 |
Department of Orthopaedics, the First People's Hospital of Huzhou, Huzhou 313000, Zhejiang, China |
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| 杨红航 |
YANG Hong-hang |
湖州市第一人民医院骨科, 浙江 湖州 313000 |
Department of Orthopaedics, the First People's Hospital of Huzhou, Huzhou 313000, Zhejiang, China |
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| 李恒 |
LI Heng |
湖州市第一人民医院骨科, 浙江 湖州 313000 |
Department of Orthopaedics, the First People's Hospital of Huzhou, Huzhou 313000, Zhejiang, China |
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| 期刊信息：《中国骨伤》2020年，第33卷，第4期，第322-326页 |
| DOI：10.12200/j.issn.1003-0034.2020.04.007 |
| 基金项目:浙江省基础公益研究计划（编号：LGF20H060009） |
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中文摘要:
目的：探讨生物型加长柄关节置换治疗高龄股骨转子间不稳定骨折的临床疗效。
方法：对2015年1月至2018年1月收治的64例高龄股骨转子间不稳定骨折患者进行回顾性分析，根据手术治疗方式分为关节置换组（生物型加长柄关节置换）及内固定组（PFNA）。关节置换组34例，男19例，女15例；年龄（81.32±3.81）岁；骨折Evans分型，Ⅲ型15例，Ⅳ型16例，Ⅴ型3例。内固定组30例，男14例，女16例；年龄（79.90±3.61）岁；骨折Evans分型，Ⅲ型10例，Ⅳ型15例，Ⅴ型5例。患者均因外伤致髋部肿痛、活动障碍，X线片及CT明确股骨转子间不稳定骨折。随访观察患者的手术时间、术中失血量、并发症情况。采用Harris髋关节功能评分及SF-36生活质量评分评价临床疗效。
结果：患者手术切口均Ⅰ期愈合。所有患者获得随访，时间13~39个月，平均23.4个月。关节置换组患者手术时间及出血量均多于内固定组（P<0.05）；关节置换组发生1例肌间静脉血栓及1例因摔伤导致后脱位，内固定组发生1例骨折不愈合，2例肌间静脉血栓，4例轻度压疮，2例内固定松动，两组并发症差异有统计学意义（χ2=4.929，P=0.026）。末次随访时，关节置换组患者髋关节Harris功能评分优于内固定组（P<0.05）；关节置换组患者SF-36生活质量评分优于内固定组（P<0.05）。
结论：采用生物型加长柄关节置换和内固定治疗股骨转子间不稳定骨折，均能获得良好的临床效果，但采用生物型加长柄关节置换治疗，术后并发症更少，髋关节功能恢复更好，患者生活质量及满意度更高。 |
| 【关键词】股骨骨折 髋骨折 关节成形术,置换,髋 骨折固定术,髓内 |
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| Medium-term efficacy of bio-lengthened stem arthroplasty in the treatment of unstable intertrochanteric femoral fractures in elderly patients |
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ABSTRACT
Objective: To explore the clinical effect of bio-lengthened stem arthroplasty replacement in the treatment of unstable intertrochanteric fractures in the elderly.
Methods: From January 2015 to January 2018,64 elderly patients with unstable intertrochanteric fractures were analyzed retrospectively. According to the surgical treatment,patients were divided into arthroplasty replacement group(bio-lengthened stem arthroplasty replacement) and internal fixation group(PFNA). In the arthroplasty group,there were 34 cases,including 19 males and 15 females,with an average age of (81.32±3.81) years old. The Evans classification of fracture was type Ⅲ in 15 cases,type Ⅳ in 16 cases and type Ⅴ in 3 cases. In the internal fixation group,there were 30 cases,including 14 males and 16 females,with an average age of (79.90±3.61) years old. The Evans classification of fracture was type Ⅲ in 10 cases,type Ⅳ in 15 cases and type V in 5 cases. X-ray and CT showed unstable intertrochanteric fracture of femur. The operation time,intraoperative blood loss and complications were observed. Harris hip function score and SF-36 life quality score were used to evaluate the clinical effect.
Results: All the incisions healed in stageⅠ. All patients were followed up for 13 to 39 months with an average of 23.4 months. The operation time and bleeding volume of the patients in the arthroplasty replacement group were more than those in the internal fixation group(P<0.05). At the final follow-up,Harris function score of hip joint in the arthroplasty group was better than that in the internal fixation group(P<0.05);SF-36 life quality score in the arthroplasty group was better than that in the internal fixation group(P<0.05).
Conclusion: The treatment of unstable intertrochanteric fractures with bio-lengthened stem arthroplasty replacement and internal fixation can achieve good clinical results,but with bio-lengthened stem arthroplasty replacement,the postoperative complications are less,the function of hip joint is better,and the life quality and satisfaction of patients are higher. |
| KEY WORDS Femoral fractures Hip fractures Arthroplasty,replacement,hip Fracture fixation,intramedullary |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 邓闽军,孙振国,闵继康,杨红航,李恒.生物型加长柄关节置换治疗高龄股骨转子间不稳定骨折的中期疗效分析[J].中国骨伤,2020,33(4):322~326 |
| 英文格式: | DENG Min-jun,SUN Zhen-guo,MIN Ji-kang,YANG Hong-hang,LI Heng.Medium-term efficacy of bio-lengthened stem arthroplasty in the treatment of unstable intertrochanteric femoral fractures in elderly patients[J].zhongguo gu shang / China J Orthop Trauma ,2020,33(4):322~326 |
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