| 舒科杰,尹良军,付廷,等.人工股骨头置换联合大转子再结合装置在高龄股骨转子间骨折中的应用.骨科,2017,8(3): 207-211. |
| 人工股骨头置换联合大转子再结合装置在高龄股骨转子间骨折中的应用 |
| Application of artificial femoral head replacement and greater trochanter reattachment in elderly patients with intertrochanteric fracture |
| 投稿时间：2016-01-23 |
| DOI：10.3969/j.issn.1674-8573.2017.03.011 |
| 中文关键词: 老年人，80岁以上 关节成形术，置换，髋 髋骨折 |
| 英文关键词: Aged, 80 and over Arthroplasty, replacement, hip Hip fractures |
| 基金项目:国家自然科学基金（81501867） |
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| 中文摘要: |
| 目的 探讨人工股骨头置换联合大转子再结合装置（greater trochanter reattachment, GTR）治疗高龄重度骨质疏松性股骨转子间粉碎性骨折的临床疗效。方法 回顾性分析我院2013年9月至2014年9月收治的48例Jensen Ⅲ、Ⅴ型股骨转子间骨折伴重度骨质疏松病人的临床资料。采用人工股骨头置换联合GTR固定的21例病人纳入GTR组，采用股骨头置换联合普通钢丝捆扎固定的27例病人纳入钢丝捆扎组。收集并比较两组病人的手术时间、术后首次下床行走时间、并发症发生率、患侧髋关节外展维持时间以及术后1、6、12个月的髋关节Harris功能评分。结果 GTR组的手术时间和术后首次下床行走时间分别为（68.86±5.47） min、（2.76±0.70） d，较钢丝捆扎组的（72.07±4.47） min、（3.52±0.85） d显著缩短（P=0.030，P=0.002）；GTR组病人术后髋关节外展维持时间为（10.81±1.78） s，较钢丝捆扎组的（9.33±1.24） s显著延长（P=0.001）；术后1个月时GTR组髋关节Harris评分为（75.71±2.39）分，明显优于钢丝捆扎组的（73.56±2.24）分（P=0.002）；但两组病人术后6、12个月的髋关节Harris功能评分和其并发症发生率的差异均无统计学意义（P均＞0.05）。结论 人工股骨头置换联合GTR治疗高龄重度骨质疏松性股骨转子间粉碎性骨折，具有操作简便、固定牢固、可行早期功能锻炼等优点，有利于改善病人的生活质量。 |
| 英文摘要: |
| Objective To observe the clinical effects of artificial femoral head replacement combined with greater trochanter reattachment (GTR) device for unstable intertrochanteric fractures in elderly patients with severe osteoporosis. Methods A retrospective analysis was made on the clinical data of 48 patients (48 hips) with intertrochanteric fractures, type Ⅲ or Ⅲ according to Jensen classification, between September 2013 to September 2014. All of the patients were diagnosed as severe osteoporosis. Twenty-one patients underwent cementless artificial femoral head replacement combined with GTR device (GTR group), and 27 patients underwent cementless artificial femoral head replacement combined with cerclage wires (cerclage wires group). The operation time of the two groups, the time of the first postoperative ambulation, the incidence of complications, the time of hip abduction, and the Harris score of the hip joint after operation at 1st, 6th and 12th month after operation were recorded and compared. Results In the GTR group, the operation time and the first postoperative walking time were (68.86±5.47) min and (2.76±0.70) days respectively, which were significantly shorter than those of cerclage wires group ［(72.07±4.47) min and (3.52±0.85) days respectively］ (P=0.030, and P=0.002). The time of keeping hip abduction in GTR group was (10.81±1.78) s, which was longer than that of cerclage wires group (P=0.001). The Harris hip scores at 1st month after operation in GTR group was 75.71±2.39, which was better than that of cerclage wires group (P=0.002). But the Harris scores at 6th, and 12th month after operation and the complication rate had no significant differences between two groups (P＞0.05 for all). Conclusion The artificial femoral head replacement combined with GTR device was a feasible and effective method to treat intertrochanteric fractures in the elderly patients with severe osteoporosis, which was easy to operate and allows early ambulation. It could also shorten the operative time and the period lying in bed, and help improve hip abduction muscle strength and early hip function, then to improve quality of patient's life. |
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