CAJ | 학술논문

目的探讨应用Zweymüller生物型加长柄关节置换治疗高龄股骨转子间骨折的手术可行性、实用性和疗效.方法回顾性分析2006年6月至2010年6月应用Zweymüller生物型加长柄关节置换治疗91例高龄股骨转子间骨折患者资料,男35例,女56例;年龄75～94岁,平均81.2岁.股骨转子间骨折按Evans-Jensen分型:Ⅲ型36例,Ⅳ型55例.骨质疏松按Singh指数分级:Ⅲ级51例,Ⅱ级40例.损伤至手术时间2～10 d,平均3.5 d.全部采用Zweymüller生物型加长柄股骨假体.根据Harris评分评价髋关节功能.结果手术时间30～50 min,平均39 min;出血量320～610 ml,平均405ml.术后91例患者切口均一期愈合,住院时间14～21 d,平均16.5 d.2例于术后第3天发生呼吸系统感染,经抗感染、化痰、平喘、机械通气等治疗痊愈;3例发生深静脉栓塞,经介入科在下腔静脉植入滤网溶栓治疗后痊愈;2例发生肺梗死,其中1例在发病2h内死亡,另1例急诊CT血管造影检查确诊后转入ICU行溶栓治疗后康复.55例患者获得随访,其中18例在此期间因其他疾病死亡,实际37例获得随访,随访时间15～38个月,平均24.5个月.末次随访时Harris评分为40～96分,其中优13例,良18例,可4例,差2例,优良率83.8％(31/37).无一例发生骨溶解、异位骨化、假体松动下沉;1例患者术后6个月摔倒致假体周围斜型骨折,行切开复位捆绑带固定15d后出院.结论 Zweymüller生物型加长柄关节置换是治疗高龄股骨转子间骨折的一种有效方法,术后患者可早期下地负重活动,功能恢复良好.
목적 탐토응용Zweymüller생물형가장병관절치환치료고령고골전자간골절적수술가행성、실용성화료효.방법 회고성분석2006년6월지2010년6월응용Zweymüller생물형가장병관절치환치료91례고령고골전자간골절환자자료,남35례,녀56례;년령75～94세,평균81.2세.고골전자간골절안Evans-Jensen분형:Ⅲ형36례,Ⅳ형55례.골질소송안Singh지수분급:Ⅲ급51례,Ⅱ급40례.손상지수술시간2～10 d,평균3.5 d.전부채용Zweymüller생물형가장병고골가체.근거Harris평분평개관관절공능.결과 수술시간30～50 min,평균39 min;출혈량320～610 ml,평균405ml.술후91례환자절구균일기유합,주원시간14～21 d,평균16.5 d.2례우술후제3천발생호흡계통감염,경항감염、화담、평천、궤계통기등치료전유;3례발생심정맥전새,경개입과재하강정맥식입려망용전치료후전유;2례발생폐경사,기중1례재발병2h내사망,령1례급진CT혈관조영검사학진후전입ICU행용전치료후강복.55례환자획득수방,기중18례재차기간인기타질병사망,실제37례획득수방,수방시간15～38개월,평균24.5개월.말차수방시Harris평분위40～96분,기중우13례,량18례,가4례,차2례,우량솔83.8％(31/37).무일례발생골용해、이위골화、가체송동하침;1례환자술후6개월솔도치가체주위사형골절,행절개복위곤방대고정15d후출원.결론 Zweymüller생물형가장병관절치환시치료고령고골전자간골절적일충유효방법,술후환자가조기하지부중활동,공능회복량호.
Objective To discuss the clinical effects of hemiarthroplasty for the treatment of intertrochanteric comminuted fracture in aged patients.Methods From June 2006 to June 2010,91 cases with intertrochanteric comminuted fractures were treated by hemiarthroplasty using Zweymtüller long-stem cementless implant.There were 35 males and 56 females,with an average age of 81.2 years (range,75-94 years).There were fresh fractures in 75 cases and old fractures in 16 cases.According to classification of Evans-Jensen,there were 36 cases with type Ⅲ fracture and 55 with type Ⅳ.Osteoporosis was graded by Singh index,and there were 51 cases with level Ⅲ and 40 with level Ⅱ.The interval between injury and operation was 2-10 d (average,3.5 d).Results The surgery lasted 30-50 min (average,39 min).The blood loss was 320-610 ml (average,405 ml).The hospital stay was 14-21 d (average,16.5 d).Two cases who experienced with the infection of the respiratory system after operation,recovered through routine treatment.Thirty-seven cases were followed up for 15 to 38 months (average,24.5 months).According to the Harris score,the overall rate of excellent or good result was 83.8％ (31/37).Conclusion Hemiarthroplasty using Zweymüller long-stem cementless prosthesis is reliable option for intertrochanteric comminuted fracture in the aged patients.