CAJ | 학술논문

目的回顾性分析采用髋关节置换术治疗股骨转子问骨折内固定失败的临床效果.方法 2004年7月至2006年6月,采用髋关节置换术治疗32例股骨转子间骨折内固定失败患者,男24例,女8例;行关节置换时的年龄为57～81,平均71岁;从骨折到行关节置换的时间为5～70个月,平均40个月.骨折内固定方式包括:滑动髋螺钉15例,髓内钉10例,钢板5例,多枚螺钉2例.失败原因:拉力螺钉切出股骨头8例,骨折不愈合9例,股骨头缺血性坏死7例,创伤性关节炎8例.采用全髋关节置换术28例(全部为生物型髋臼),双极人工股骨头置换术4例.骨水泥型股骨柄12例,非骨水泥型股骨柄20例.标准股骨假体25例,长柄股骨假体7例.结果术后28例患者获得随访,随访时间4～6年,平均5年.28例患者术前Harris评分平均37分(32～45分),末次随访时平均88分(84～95分);优6例,良14例,可7例,差1例.末次随访时X线片显示假体位置正常,髋臼平均外展角为44°(42°～48°),髋臼假体无松动.根据Harris标准评价骨水泥型股骨假体固定,1例为A级,9例为C级.根据Engh等标准评价非骨水泥型股骨假体的固定,18例均评价为骨长入.3例髋关节术后6个月复查时发现异位骨化,BrookerⅡ级2例,Ⅲ级1例.结论髋关节置换术是老年患者股骨转子问骨折内固定治疗失败后的一种有效挽救选择.
목적 회고성분석채용관관절치환술치료고골전자문골절내고정실패적림상효과.방법 2004년7월지2006년6월,채용관관절치환술치료32례고골전자간골절내고정실패환자,남24례,녀8례;행관절치환시적년령위57～81,평균71세;종골절도행관절치환적시간위5～70개월,평균40개월.골절내고정방식포괄:활동관라정15례,수내정10례,강판5례,다매라정2례.실패원인:랍력라정절출고골두8례,골절불유합9례,고골두결혈성배사7례,창상성관절염8례.채용전관관절치환술28례(전부위생물형관구),쌍겁인공고골두치환술4례.골수니형고골병12례,비골수니형고골병20례.표준고골가체25례,장병고골가체7례.결과 술후28례환자획득수방,수방시간4～6년,평균5년.28례환자술전Harris평분평균37분(32～45분),말차수방시평균88분(84～95분);우6례,량14례,가7례,차1례.말차수방시X선편현시가체위치정상,관구평균외전각위44°(42°～48°),관구가체무송동.근거Harris표준평개골수니형고골가체고정,1례위A급,9례위C급.근거Engh등표준평개비골수니형고골가체적고정,18례균평개위골장입.3례관관절술후6개월복사시발현이위골화,BrookerⅡ급2례,Ⅲ급1례.결론 관관절치환술시노년환자고골전자문골절내고정치료실패후적일충유효만구선택.
Objective To respectively analyze the results and complications of hip arthroplasty for failed intertrochanteric hip fractures treating with internal fixation.Methods From July 2004 to June 2006,32 patients(24 males and 8 females)were treated with hip arthroplasty after the failed internal fixation of intertrochanteric fractures.The mean age was 71 years(range,57-81 years)at the time of the hip arthroplasty.The average interval from fracture to arthroplasty was 40 months(range,5-70 months).Fifteen patients had been treated with sliding hip screw,10 with intramedullary nail,5 with plate and screws,2 with multiple screws.The failure modes were nonunion in 8 patients,implant cut out from the femoral head in 9,avascular necrosis of the femoral head in 7,and traumatic arthritis in 8 patients.Cemented stems were used in 12 hips,and uncemented stems in 20 hips.Standard prostheses were used in 25,long-stem prostheses in 7.Results Twenty-eight patients were followed up for a minimum of 4 years after the hip arthroplasty,with the mean period of 5 years(range,4-6 yeas).For these 28 patients,the average preoperative Harris Hip Score was 37(range,32-45),and 88(range,84-95)at the latest follow-up.The average acetabular inclination was 44°(range,42°-48°).No loosing was found in cotyloid components.Nine of 10 cemented femoral components had cementation rated as grade C,and 1 as grade A.Three had heterotopic bone six months postoperatively,and 2 were Brooker type Ⅱ,one was type Ⅲ.Conclusion Hip arthroplasty is an effective salvage procedure after the failed treatment of an intertrochanteric fracture in an older patient.