CAJ | 학술논문

背景:治疗股骨转子间骨折内固定的方法有动力髋螺钉、Gamma钉、股骨近端髓内钉、角钢板、股骨近段锁定钢板等,其中以动力髋螺钉应用最为广泛,但其失败率也逐渐增加.目的:观察人工全髋关节置换治疗老年股骨转子间骨折应用动力髋螺钉内固定失败的病例特征.方法:于2004/2007应用人工全髋关节置换治疗老年股骨转子间骨折动力髋螺钉内固定失败病例4例,患者为自行跌倒,按Evans分型,Ⅱ型1例,ⅢA型2例,ⅢB型1例.动力髋螺钉置入后6个月-1年出现内固定物移位,股骨头切割,骨折不愈合,髋内翻畸形,髋部疼痛,不能行走.继之采用骨水泥髋臼假体,按45°外展角,10°～15°前倾角置入.人工全髋关节置换后按照Harris评分标准进行疗效评价.结果与结论:4例患者手术顺利,手术时间1.5～2 0 h,术中出血量400～600mL,未出现骨水泥过敏反应.置换后无切口感染,无脱位,无坠积性肺炎,无压疮.经3～12个月随访,未出现假体松动、下沉,髋关节功能满意,摄片人工关节在位,假体匹配良好,Harris评分平均81分.结果提示老年股骨转子间骨折动力髋螺钉内固定失败后应用人工全髋关节置换,可缩短患者卧床时间,减少并发症,改善髋关节功能.
배경:치료고골전자간골절내고정적방법유동력관라정、Gamma정、고골근단수내정、각강판、고골근단쇄정강판등,기중이동력관라정응용최위엄범,단기실패솔야축점증가.목적:관찰인공전관관절치환치료노년고골전자간골절응용동력관라정내고정실패적병례특정.방법:우2004/2007응용인공전관관절치환치료노년고골전자간골절동력관라정내고정실패병례4례,환자위자행질도,안Evans분형,Ⅱ형1례,ⅢA형2례,ⅢB형1례.동력관라정치입후6개월-1년출현내고정물이위,고골두절할,골절불유합,관내번기형,관부동통,불능행주.계지채용골수니관구가체,안45°외전각,10°～15°전경각치입.인공전관관절치환후안조Harris평분표준진행료효평개.결과여결론:4례환자수술순리,수술시간1.5～2 0 h,술중출혈량400～600mL,미출현골수니과민반응.치환후무절구감염,무탈위,무추적성폐염,무압창.경3～12개월수방,미출현가체송동、하침,관관절공능만의,섭편인공관절재위,가체필배량호,Harris평분평균81분.결과제시노년고골전자간골절동력관라정내고정실패후응용인공전관관절치환,가축단환자와상시간,감소병발증,개선관관절공능.
BACKGROUND:Many internal fixations,such as dynamic hip screw,Gamma screw,proximal femoral nail,angle steel plate,as well as locking proximac femoral plate,are utilized in treating intertrochanteric fractures,especially the dynamic hip screw However,the failure rate is gradually increased.OBJECTIVE:To explore the application and clinical efficacy of total hip replacement for the treatment of elderly intertrochanteric fracture fixation after failure of dynamic hip screw.METHODS:A total of four cases with intertrochanteric fractures were treated by total hip replacement after failure of dynamic hip screw fixation was selected.According to Evans typing,one case were type Ⅱ,two cases were type Ⅲ A,and one case was typeⅢB.Internal fixation displacement could be found at half to 1 year after dynamic hip screw fixation.Because of bone disunion,coxa adducta and pain,the patients could not walk.Sequentially,total hip replacement was performed with 45°abduct angle and10°-15°anteversion angle The clinical efficacy was evaluated by Harris scoring criteria.RESULTS AND CONCLUSION:All the cases were operated smoothly,with 1.5-2 hour operation duration and 400-600 mL blood loss.No case appeared allergic response to bone cement.By 3-12 months follow-up,4 successful operative cases do not appear prosthesis loosening,subsidence and are satisfied with well hip function.The average Harris score were 81 points.The results revealed that application of total hip replacement after the failure of DHS in elderly intertrochanteric fracture fixation,which shortened the time patients stay in bed to reduce complications and improved the hip joint function.