摘要
背景:由于高龄股骨转子间骨折患者行内固定治疗卧床时间长,内固定失败率高等原因,近年来人工关节置换的方法成为高龄股骨转子间骨折患者治疗的一种选择。目的:从手术时间、术中出血量、术后下床锻炼时间、材料与宿主的生物相容性以及Harris评分等方面分析了股骨转子间骨折与股骨颈骨折患者行人工股骨头置换疗效。设计、时间及地点:回顾性病例资料对比分析,2000-01/2004-12赣南医学院第一附属医院。对象:42例新鲜股骨转子间骨折患者,男14例,女28例,年龄70～95岁,平均78.2岁。52例股骨颈骨折中男22例,女30例。年龄70～91岁,平均73.3岁。两组患者在年龄分布、骨折类型、手术时机等方面差异均无显著性,具有可比性(P>0.05)。方法:入院后患肢暂时行皮肤牵引维持,积极治疗内科并存症,一般情况稳定后按标准手术操作规程进行人工股骨头置换。术中选择颈长合适的股骨假体用骨水泥固定于股骨上端髓腔内。主要观察指标:①两组材料与宿主的生物相容性比较。②两组手术时间、术中出血量、术后下床锻炼时间、Harris评分比较。③两组并发症比较。结果:转子间骨折组平均随访4.6年,股骨颈骨折组平均随访4.9年。①在深静脉血栓、髋关节间隙变化、疼痛、假体柄松动下沉等方面,两组比较差异无显著性意义(P>0.05)。两组假体翻修率差异无显著性意义(P>0.05)。②术中出血量、术后下床锻炼时间、Harris评分差异无显著性意义(P>0.05)。转子间骨折组比股骨颈骨折组手术时间长,差异有显著性意义(P<0.05)。③转子间骨折组比股骨颈骨折组术后出现双下肢不等长的可能性高,差异有显著性意义(P<0.05)。结论:使用标准骨水泥型股骨假体,股骨转子间骨折行人工股骨头置换取得了与股骨颈骨折行人工股骨头置换相同的治疗效果。
BACKGROUND： Due to long-term bed rest and high failure of internal fixation for interochanteric fracture in elderly patients, artificial joint replacement has become an option for them in recent years. OBJECTIVE： To compare the clinical outcome of femoral head replacement for intertrochanteric fractures and femoral neck fractures in patients over 70 years old through surgery duration, blood loss, activity time post-surgery, biocompatibility between host and material and Harris scores. DESIGN, TIME AND SETTING： Retrospective case analysis was performed at the First Hospital of Gannan Medical College between January 2000 and December 2004. PARTICIPANTS： Forty-two cases of femoral intertrochanteric fractures, 14 males and 28 females with an average of 78.2 years （range 70 95 years）, and 52 cases of femoral neck fractures, 22 males and 30 females, with an average of 73.3 years （range 70 91 years） were enrolled. There were no significant differences between two groups in terms of age, fracture type and operation time （P 〉 0.05）. METHODS： Skin traction was performed following admission, and the internal complications were treated. Femoral head replacement was performed according to standard surgery procedure when the condition of patients was stable. Appropriate femoral prosthesis was selected and fixed to the medullary cavity of superior femur using bone cement. MAIN OUTCOME MEASURES： Comparison of biocompatibility between material and host in two groups; operation duration blood loss, activity time post-surgery, and Harris scores; complications following surgery. RESULTS： The intertrochanteric fracture group was followed-up for 4.6 years averagely and the femoral neck fracture group for 4.9 years. There were no significant differences in deep venous thrombosis, hip joint space, pain, and prosthesis stem loosening or subsidence （P 〉 0.05）. There were also significant differences in revision rate between two groups （P 〉 0.05）. In addition, blood loss, the time of exercise after operation, and Harris scores were not statistically different between two groups （P 〉 0.05）. The operation time in the intertrochanteric fracture group was significantly longer than the femoral neck fracture group （P 〈 0.05）. The incidence of inequality of lower limbs post-surgery in the intertrochanteric fracture group was significantly larger than the femoral neck fracture group （P 〈 0.05）. CONCLUSION： With standard cemented prostheses, femoral head replacement can achieve similar functional outcomes for patients with intertrochanteric fractures or femoral neck fractures.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2008年第35期6879-6882,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
