雙極股骨頭置換合并張力帶鋼絲固定治療高齡骨質疏松性股骨轉子間骨折_《中國修復重建外科雜志》

作者：

張華 , 張健 , 周愛國 , 蔣電明 , 沈洪林 , 閆文龍

重慶醫科大學附屬第一醫院骨科（重慶，400016）;

關鍵詞：

股骨轉子間骨折骨質疏松雙極股骨頭置換高齡患者

DOI：

10.7507/1002-1892.20130213

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目的探討雙極股骨頭置換結合張力帶鋼絲固定治療高齡骨質疏松性股骨轉子間骨折的療效。方法2004年1月－2010年12月，應用雙極股骨頭置換結合張力帶鋼絲固定治療48例90歲以上骨質疏松性股骨轉子間骨折。男15例，女33例；年齡90～99歲，平均94.1歲。均為跌倒致傷，排除病理性骨折。骨折至手術時間2～7 d，平均4.2 d。骨折按Tronzo Evans分型標準，Ⅳ型25例，Ⅲ 型20例，Ⅱ型 3例。均伴嚴重骨質疏松；均合并1種以上內科疾病，合并脊柱壓縮性骨折10例。結果患者均順利完成手術，術后2年內因內科疾病死亡6例；存活患者中39例獲隨訪，隨訪時間2～7年，平均3.1年。術后出現短期精神障礙9例，可疑尿路感染2例，骶尾部褥瘡1例，遺留髖部疼痛1例，大腿疼痛1例，患側下肢深靜脈血栓形成1例。術后患者切口均Ⅰ期愈合。X線片檢查示骨折均愈合，隨訪期間無骨溶解及假體松動、下沉、斷裂，未見明顯異位骨化發生；均無假體翻修。術后2年Harris評分獲優5例，良28例，可5例，差1例，優良率達84.6%；評分顯著高于術后6周，差異有統計學意義（t= —14.79，P=0.00）。術后2年生命質量量表（SF-12）評分顯著高于術后6周，差異均有統計學意義（P lt; 0.05）。術后6周及2年VAS評分均顯著低于術前，術后2年低于術后6周，差異均有統計學意義（P lt; 0.05）。結論采用雙極股骨頭置換結合張力帶鋼絲固定治療高齡骨質疏松性股骨轉子間骨折固定牢固，允許患者早期負重鍛煉、緩解疼痛，改善髖關節功能，減少臥床并發癥的發生。

引用本文： 張華,張健,周愛國,蔣電明,沈洪林,閆文龍. 雙極股骨頭置換合并張力帶鋼絲固定治療高齡骨質疏松性股骨轉子間骨折. 中國修復重建外科雜志, 2013, 27(8): 980-984. doi: 10.7507/1002-1892.20130213 復制

1.	Lorich DG, Geller DS, Nielson JH. Osteoporotic pertrochanteric hip fractures: management and current controversies. Instr Course Lect, 2004, 53: 441-454.
2.	Kyle RF, Cabanela ME, Russell TA, et al. Fractures of the proximal part of the femur. Instr Course Lect, 1995, 44: 227-253.
3.	Stea S, Bordini B, De Clerico M, et al. First hip arthroplasty register in Italy: 55000 cases and 7 years follow-up. Int Orthop, 2009, 33(2): 339-346.
4.	Chan KC, Gill GS. Cemented hemiarthroplasties for elderly patients with intertrochanteric fractures. Clin Orthop Relat Res, 2000, (371): 206-215.
5.	Anglen JO, Weinstein JN, American Board of Orthopaedic Surgery Research Committee. Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg (Am), 2008, 90(4): 700-707.
6.	中華醫學會骨質疏松和骨礦鹽疾病分會. 原發性骨質疏松癥診治指南(2011年). 中華骨質疏松和骨礦鹽疾病雜志, 2011, 4(1): 2-17.
7.	Kim WY, Han CH, Park JI, et al. Failure of intertrochanteric fracture fixation with a dynamic hip screw in relation to pre-operative fracture stability and osteoporosis. Int Orthop, 2001, 25(6): 360-362.
8.	Haentjens P, Casteleyn PP, Opdecam P. Hip arthroplasty for failed internal fixation of intertrochanteric and subtrochanteric fractures in the elderly patient. Arch Orthop Trauma Surg, 1994, 113(4): 222-227.
9.	Dean BJ, Matthews JJ, Price A, et al. Modular endoprosthetic replacement for failed internal fixation of the proximal femur following trauma. Int Orthop, 2012, 36(4): 731-734.
10.	Hsu CJ, Chou WY, Chiou CP, et al. Hemi-arthroplasty with supplemental fixation of greater trochanter to treat failed hip screws of femoral intertrochanteric fracture. Arch Orthop Trauma Surg, 2008, 128(8): 841-845.
11.	D’Arrigo C, Perugia D, Carcangiu A, et al. Hip arthroplasty for failed treatment of proximal femoral fractures. Int Orthop, 2010, 34(7): 939-942.
12.	Haentjens P, Lamraski G. Endoprosthetic replacement of unstable, comminuted intertrochanteric fracture of the femur in the elderly, osteoporotic patient: a review. Disabil Rehabil, 2005, 27(18-19): 1167-1180.
13.	張前法, 龐清江, 黃濤, 等. 雙極長柄人工股骨頭置換治療高齡粉碎性股骨轉子間骨折的臨床應用. 中國修復重建外科雜志, 2005, 19(3): 198-200.
14.	Grimsrud C, Monzon RJ, Richman J, et al. Cemented hip arthroplasty with a novel cerclage cable technique for unstable intertrochanteric hip fractures. J Arthroplasty, 2005, 20(3): 337-343.
15.	Haidukewych GJ, Berry DJ. Hip arthroplasty for salvage of failed treatment of intertrochanteric hip fractures. J Bone Joint Surg (Am), 2003, 85-A(5): 899-904.
16.	張健, 安洪, 周愛國, 等. 保留股骨距的骨水泥型雙動半髖人工關節置換治療高齡轉子間骨折. 激光雜志, 2006, 27(3): 94-95.
17.	唐際存, 王梨明, 胡譯文, 等. 矩形柄人工髖關節置換治療老年股骨轉子間粉碎性骨折. 中國修復重建外科雜志, 2011, 25(11): 1400-1402.
18.	朱建煒, 劉璠, 張烽, 等. 人工股骨頭置換治療高齡股骨轉子間骨折. 中國修復重建外科雜志, 2008, 22(11): 1400-1401.

1. Lorich DG, Geller DS, Nielson JH. Osteoporotic pertrochanteric hip fractures: management and current controversies. Instr Course Lect, 2004, 53: 441-454.
2. Kyle RF, Cabanela ME, Russell TA, et al. Fractures of the proximal part of the femur. Instr Course Lect, 1995, 44: 227-253.
3. Stea S, Bordini B, De Clerico M, et al. First hip arthroplasty register in Italy: 55000 cases and 7 years follow-up. Int Orthop, 2009, 33(2): 339-346.
4. Chan KC, Gill GS. Cemented hemiarthroplasties for elderly patients with intertrochanteric fractures. Clin Orthop Relat Res, 2000, (371): 206-215.
5. Anglen JO, Weinstein JN, American Board of Orthopaedic Surgery Research Committee. Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg (Am), 2008, 90(4): 700-707.
6. 中華醫學會骨質疏松和骨礦鹽疾病分會. 原發性骨質疏松癥診治指南(2011年). 中華骨質疏松和骨礦鹽疾病雜志, 2011, 4(1): 2-17.
7. Kim WY, Han CH, Park JI, et al. Failure of intertrochanteric fracture fixation with a dynamic hip screw in relation to pre-operative fracture stability and osteoporosis. Int Orthop, 2001, 25(6): 360-362.
8. Haentjens P, Casteleyn PP, Opdecam P. Hip arthroplasty for failed internal fixation of intertrochanteric and subtrochanteric fractures in the elderly patient. Arch Orthop Trauma Surg, 1994, 113(4): 222-227.
9. Dean BJ, Matthews JJ, Price A, et al. Modular endoprosthetic replacement for failed internal fixation of the proximal femur following trauma. Int Orthop, 2012, 36(4): 731-734.
10. Hsu CJ, Chou WY, Chiou CP, et al. Hemi-arthroplasty with supplemental fixation of greater trochanter to treat failed hip screws of femoral intertrochanteric fracture. Arch Orthop Trauma Surg, 2008, 128(8): 841-845.
11. D’Arrigo C, Perugia D, Carcangiu A, et al. Hip arthroplasty for failed treatment of proximal femoral fractures. Int Orthop, 2010, 34(7): 939-942.
12. Haentjens P, Lamraski G. Endoprosthetic replacement of unstable, comminuted intertrochanteric fracture of the femur in the elderly, osteoporotic patient: a review. Disabil Rehabil, 2005, 27(18-19): 1167-1180.
13. 張前法, 龐清江, 黃濤, 等. 雙極長柄人工股骨頭置換治療高齡粉碎性股骨轉子間骨折的臨床應用. 中國修復重建外科雜志, 2005, 19(3): 198-200.
14. Grimsrud C, Monzon RJ, Richman J, et al. Cemented hip arthroplasty with a novel cerclage cable technique for unstable intertrochanteric hip fractures. J Arthroplasty, 2005, 20(3): 337-343.
15. Haidukewych GJ, Berry DJ. Hip arthroplasty for salvage of failed treatment of intertrochanteric hip fractures. J Bone Joint Surg (Am), 2003, 85-A(5): 899-904.
16. 張健, 安洪, 周愛國, 等. 保留股骨距的骨水泥型雙動半髖人工關節置換治療高齡轉子間骨折. 激光雜志, 2006, 27(3): 94-95.
17. 唐際存, 王梨明, 胡譯文, 等. 矩形柄人工髖關節置換治療老年股骨轉子間粉碎性骨折. 中國修復重建外科雜志, 2011, 25(11): 1400-1402.
18. 朱建煒, 劉璠, 張烽, 等. 人工股骨頭置換治療高齡股骨轉子間骨折. 中國修復重建外科雜志, 2008, 22(11): 1400-1401.

《中國修復重建外科雜志》

雙極股骨頭置換合并張力帶鋼絲固定治療高齡骨質疏松性股骨轉子間骨折

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《中國修復重建外科雜志》

雙極股骨頭置換合并張力帶鋼絲固定治療高齡骨質疏松性股骨轉子間骨折

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