CAJ | 학술논문

背景:股骨转子间骨折传统的手术治疗方法有动力髋螺钉、动力髁螺钉、股骨近端髓内钉,甚至股骨近端锁定钢板、经皮微创钢板固定,疗效肯定.但此类方法并非适应所有转子间骨折,尤其是年龄在75岁以上的高龄患者,转子间骨折多为不稳定型,大多合并有内科疾病,内固定失败率较高.目的:探讨骨水泥型人工关节置换治疗高龄不稳定型股骨转子间骨折的手术方法和疗效.方法:高龄不稳定型股骨转子间骨折27例,男11例,女16例,平均年龄84.6岁.采用髋关节后外侧改良Gibson入路,将大转子解剖复位,作为测量肢体长度和安装假体的一个重要标志.所有患者均使用骨水泥加长股骨假体柄,除2例合并有髋关节炎的患者行全髋置换外,其余患者均为双动股骨头置换.结果与结论:本组患者均安全渡过手术期,术后开始负重行走时间为置换后7-16 d.27例随访6-48个月,平均20个月,随访期间未出现假体松动、下沉等,骨折有满意骨痂生长.置换后6个月Harris髋关节功能评分78-94分,平均达85.4分,优良率达78%.1例因护理不当发生髋关节后脱位,2例在住院期间发生下肢深静脉血栓,经相应治疗后均痊愈.提示骨水泥型人工关节置换治疗高龄不稳定型股骨转子间骨折具有卧床时间短,能早期负重行走,并发症少,肢体功能恢复佳等优点,近期效果满意.
배경:고골전자간골절전통적수술치료방법유동력관라정、동력과라정、고골근단수내정,심지고골근단쇄정강판、경피미창강판고정,료효긍정.단차류방법병비괄응소유전자간골절,우기시년령재75세이상적고령환자,전자간골절다위불은정형,대다합병유내과질병,내고정실패솔교고.목적:탐토골수니형인공관절치환치료고령불은정형고골전자간골절적수술방법화료효.방법:고령불은정형고골전자간골절27례,남11례,녀16례,평균년령84.6세.채용관관절후외측개량Gibson입로,장대전자해부복위,작위측량지체장도화안장가체적일개중요표지.소유환자균사용골수니가장고골가체병,제2례합병유관관절염적환자행전관치환외,기여환자균위쌍동고골두치환.결과여결론:본조환자균안전도과수술기,술후개시부중행주시간위치환후7-16 d.27례수방6-48개월,평균20개월,수방기간미출현가체송동、하침등,골절유만의골가생장.치환후6개월Harris관관절공능평분78-94분,평균체85.4분,우량솔체78%.1례인호리불당발생관관절후탈위,2례재주원기간발생하지심정맥혈전,경상응치료후균전유.제시골수니형인공관절치환치료고령불은정형고골전자간골절구유와상시간단,능조기부중행주,병발증소,지체공능회복가등우점,근기효과만의.
BACKGROUND: Traditional treatment of intertrochanteric fractures includes dynamic hip screw (DHS), dynamic condylar screw (DCS), proximal femoral nail (PFN) and locking compress plate (LCP), most of them have positive results. However, these techniques are not utility for all patients with intertrochanteric fractures, especially for the senile patients whose ages are over 75 years. The intertrochanteric fractures are usually unstable, and most of them have medical complications, thus all these lead to a high failure rate of internal fixation. OBJECTIVE: To identify the methods and the therapeutic effects of hemiarthroplasty or arthreplasty with bone cement for unstable intertrochanteric fractures in senile patients. METHODS: There were 27 senile patients with unstable intertrochanteric fractures, including 11 males and 16 females, with the mean age of 84.6 years. All patients were adopted improved Gibson approach, and greater trochanter should be reduced anatomically as an important sign for measuring the lengths of the lower extremities and fixing of prostheses. Long-stem cementless calcar-raplacements were used in all patients, 2 arthroplasty owing to preexisting osteoarthritis and 25 hemiarthroplasty. RESULTS AND CONCLUSION: Nobody was dead during perioperative period. Weight bearing was permitted as soon as acute pain subsides (7-16 days after operation); 27 patients were followed up for 6 to 48 months, for 20 months on average. No prosthetic looseness and sinking happened, and the calluses were well mineralized. The Harris score was used to evaluate the therapeutic effect at 6 months after operation, which was 78 to 94, of 85.4 points on average, and the rate of fineness was 78%. One posterior hip dislocation and two deep venous thrombosis (DVT) of lower extremities occurred owing to improper caring. The results showed that the prosthetic replacement with bone cement is a reasonable preference for unstable intertrochanteric fractures in senile patients because of many virtues, such as earlier period weight bearing out of bed, low incidence of complications, and satisfaction of functional recovery of extremities.