【摘要】 背景:老年骨质疏松症患者股骨转子间骨折行人工股骨头置换是一个具有挑战性的问题。目的:探讨采用先安装关节后骨折复位治疗高龄患者股骨转子间不稳定性骨折的临床疗效。方法:纳入老年股骨转子间不稳定性骨折患者21例,均采用人工股骨头置换治疗,同时收集20例老年股骨转子间不稳定性骨折应用动力髋螺钉内固定治疗患者的临床资料,对比分析两组在手术时间、术中出血量、内固定置换后下地活动时间、并发症、Harris评分的差异,主要观察人工股骨头置换患者的临床疗效。结果与结论:所有患者均获得随访,平均随访时间20个月(6-36个月),置换后切口均Ⅰ期愈合,采用股骨头置换手术时间短、术中出血量少、置换治疗后下地活动时间早,但两组间Harris评分比较,差异无显著性意义(P>0.05)。行人工股骨头置换后无感染、内翻移位及髋关节松动等并发症。结果说明,老年人股骨转子间骨折实施人工关节置换先确定好股骨假体正确的前倾角、偏心距及股骨距长短,在植入股骨假体后再做转子和股骨距骨性标志的复位固定,是一种简单易行的手术操作,可减少出血量、缩短手术时间、提高临床疗效。更多还原

【Abstract】 BACKGROUND: Undergoing femoral head replacement in senile osteoporosis patients with intertrochanteric fracture is a challenging problem. OBJECTIVE: To explore the clinical effect of the use of joint installation and fracture reduction on the treatment of unstable intertrochanteric fractures in elderly patients. METHODS: A total of 21 elderly patients with unstable intertrochanteric fractures underwent femoral head replacement. Simultaneously, we collected clinical data of 20 elderly patients with unstable intertrochanteric fractures undergoing internal fixation of dynamic hip screw. Operation time, blood loss amount, time of walking practice after replacement, complications, and Harris score were compared between the two groups. Clinical effects in patients with femoral head replacement were observed. RESULTS AND CONCLUSION: All patients were followed up for averagely 20 months(ranged from 6 months to 36 months). After replacement, the incision was first healing. The operation time of femoral head replacement was short; blood loss amount was less; the time of walking practice was early. However, no significant difference in Harris score was detected between the two groups(P > 0.05). After femoral head replacement, no infection, inversion and shift, or hip joint loose occurred. Results suggested that correct anteversion angle, eccentricity and femoral calcar size should be identified before the implementation of artificial joint replacement for the elderly femoral intertrochanteric fracture. After implantation of the prosthesis, reduction and fixation of trochanter and femoral calcar bony landmarks are simple easily operated surgery. It can reduce blood loss amount, shorten operation time and elevate clinical effects.更多还原