| 远端固定型假体治疗高龄股骨转子间不稳定骨折的中期随访疗效分析 |
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Received:October 20, 2015
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| 作者 | Author | 单位 | Unit | E-Mail |
| 张占丰 |
ZHANG Zhan-feng |
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 |
mjk@medmail.com.cn |
| 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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| 钟建明 |
ZHONG Jian-ming |
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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| 王丹 |
WANG Dan |
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》2016年29卷，第6期，第491-495页 |
| DOI：10.3969/j.issn.1003-0034.2016.06.002 |
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| 目的: 探讨远端固定型假体治疗高龄股骨转子间不稳定骨折的中期疗效。方法: 自2008年5月至2014年3月,对收治的58例高龄股骨转子间不稳定骨折患者采用远端固定型假体治疗,其中男15例,女43例;年龄75～87岁,平均83.2岁。根据Evans分型,Ⅰc型39例,Ⅰd型19例。所有患者术前评估手术风险,行人工全髋关节置换术9例,人工股骨头置换术49例。对不同年龄段、不同Evans分型、远端固定假体类型、辅助固定方式的患者采用髋关节Harris评分评价其髋关节功能。结果: 56例获得随访,时间13～36个月,平均21.6个月。根据Harris评分,优5例,良38例,中13例,总分(83.51±6.40)分。75～80岁组Harris评分88.64±2.35,>80岁组Harris评分81.64±6.40,差异有统计学意义(P<0.05);Evans Ⅰc型组Harris评分83.64±6.53,Evans Ⅰd型组Harris评分83.11±6.08,差异无统计学意义(P>0.05);使用张力带组Harris评分83.63±6.15,不使用张力带组Harris评分82.41±6.57,差异无统计学意义(P>0.05);普通远端固定型假体组Harris评分83.34±6.43,股骨矩重建型远端固定型假体组Harris评分83.92±6.51,差异无统计学意义(P>0.05).随访期间1例术侧髋关节脱位,手法复位后再脱位,接受手术切开复位。2例出现股骨近端骨溶解,无明显症状,采取保守治疗。结论: 以人工关节置换术治疗高龄的股骨转子间不稳定骨折,年龄>80岁的患者术后髋关节功能更差,骨折类型、是否使用张力带固定骨折、远端固定假体类型对术后功能无明显影响,同时股骨近端骨溶解是值得重视的并发症。 |
| [关键词]:股骨 骨折 外固定器 假体和植入物 关节成形术,置换,髋 |
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| Distal fixation prosthesis for unstable intertrochanteric fractures in elderly patients:a mid-term follow-up study |
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| Abstract:Objective: To explore mid-term follow up results of distal fixation prosthesis in treating unstable intertrochanteric fractures in elderly patients. Methods: From May 2008 to March 2014,58 elderly patients with unstable intertrochanteric were treated with distal fixation prosthesis,among them,there were 15 males and 43 females aged from 75 to 87 years old with an average of 83.2 years old. Fracture were classified according to Evans classification,39 cases were type Ⅰc and 19 cases were typeⅠd. Surgical risk was evaluated before operation,9 patients were performed total hip arthroplasty and 49 patients were performed prosthetic replacement hip joint function of patients with different age period,Evans classificaton,prothesis type,fixation method were evaluated respectively by using Harris score. Results: Fifty-six patients were followed up from 13 to 36 months with an average of 21.6 months. Harris score was 83.51±6.40,5 cases got excellent results,38 cases good and 13 cases moderate. Harris score of patients aged from 75 to 80 years old was 88.64±2.35,81.64±6.40 in patients aged more than 80 years old,and had significant differences between two groups;Harris score in patients with type Evans Ⅰc was 83.64±6.53,and 83.11±6.08 in type Evans Ⅰd,while there was no significant differences between two groups. There was no obvious meaning in Harris score between patients with tension band (83.63±6.15) and without tension band (82.41±6.57). There was no significant meaning in Harris score between patients with normal distal fixation prosthesis (83.34±6.43) and femoral moment reconstruction distal fixation prosthesis (83.92±6.51). There was 1 patient occurred hip joint dislocation on the operative side and re-dislocation after manual reduction,then received open reduction. Two patients occurred femoral osteolysis without clinical symptoms,and treated conservative treatment. Conclusion: Artificial joint replacement for unstable intertrochanteric fractures in elderly patients,hip joint function in patients aged more than 80 years old is worse,while there was no obvious market effect in fracture classification,whether to use tension band and type of distal fixation prosthesis,moreover,proximal femoral osteolysis should be focused on. |
| KEYWORDS:Femur Fractures External fixators Prostheses and implants 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: | 张占丰,闵继康,钟建明,王丹.远端固定型假体治疗高龄股骨转子间不稳定骨折的中期随访疗效分析[J].中国骨伤,2016,29(6):491~495 |
| 英文格式: | ZHANG Zhan-feng,Min Ji-kang,ZHONG Jian-ming,WANG Dan.Distal fixation prosthesis for unstable intertrochanteric fractures in elderly patients:a mid-term follow-up study[J].zhongguo gu shang / China J Orthop Trauma ,2016,29(6):491~495 |
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