CAJ | 학술논문

目的探讨老年转子间骨折治疗失败后髋关节置换的方式及效果. 方法 2004 -2009年收治老年转子间骨折治疗失败患者10例,其中男4例,女6例；年龄68～84岁,平均75.7岁.骨折初次治疗包括动力髋螺钉(DHS)固定3例,动力髁螺钉(DCS)固定1例,股骨近端重建钉固定3例,保守治疗无内固定3例.治疗失败包括股骨头坏死4例,内固定切割3例,骨折不愈合2例,畸形愈合合并骨关节炎1例.术前检查除外感染,行髋关节置换术.随访时记录Harris评分,影像学评估假体位置. 结果全髋置换术6例,其中髋臼骨水泥固定3例,非骨水泥固定3例；股骨头置换4例.股骨假体使用加长柄5例,普通柄5例.手术中失血量平均764 ml,手术时间平均128 min.术中发现股骨距缺损3例,大转子尖骨质阻挡髓腔入点7例；安放假体复位后,转子与髋臼存在撞击3例；术后发现骨水泥从既往内固定钉孔内侧渗漏3例.随访2～7年,Harris 评分由术前37分改善为85分.无血栓、感染、骨折、脱位发生,其中1例2年后因脑出血死亡.结论老年转子间骨折治疗失败后,髋关节置换术可以允许患者早期下地活动,缩短卧床时间,是一种有效的治疗方式.但是,应该注意其骨质疏松、骨质缺损、解剖结构的改变以及既往内固定物影响等特点,减少并发症的发生.
목적 탐토노년전자간골절치료실패후관관절치환적방식급효과. 방법 2004 -2009년수치노년전자간골절치료실패환자10례,기중남4례,녀6례；년령68～84세,평균75.7세.골절초차치료포괄동력관라정(DHS)고정3례,동력과라정(DCS)고정1례,고골근단중건정고정3례,보수치료무내고정3례.치료실패포괄고골두배사4례,내고정절할3례,골절불유합2례,기형유합합병골관절염1례.술전검사제외감염,행관관절치환술.수방시기록Harris평분,영상학평고가체위치. 결과 전관치환술6례,기중관구골수니고정3례,비골수니고정3례；고골두치환4례.고골가체사용가장병5례,보통병5례.수술중실혈량평균764 ml,수술시간평균128 min.술중발현고골거결손3례,대전자첨골질조당수강입점7례；안방가체복위후,전자여관구존재당격3례；술후발현골수니종기왕내고정정공내측삼루3례.수방2～7년,Harris 평분유술전37분개선위85분.무혈전、감염、골절、탈위발생,기중1례2년후인뇌출혈사망.결론 노년전자간골절치료실패후,관관절치환술가이윤허환자조기하지활동,축단와상시간,시일충유효적치료방식.단시,응해주의기골질소송、골질결손、해부결구적개변이급기왕내고정물영향등특점,감소병발증적발생.
Objective To evaluate the results and complications of hip arthroplasty performed as a salvage procedure after the failed treatment of intertrochanteric hip fractures in elderly patients. Methods Between 2004 and 2009,10 patients were treated with hip arthroplasty after the failed treatment of intertrochanteric fracture.There were six females and four males,at mean age of 75.7 years ( range,68-84 years).The initial treatment of fractures included dynamic hip screw (DHS) fixation in three cases,dynamic condyle screw (DCS) fixation in one,proximal femur fixation with reconstruction interlocking nail in three and conservative treatment without internal fixation in three.The failed procedures included avascular necrosis in four cases,cephalic implant cutting in three,nonunion in two and malunion associated with osteoarthritis in one.Joint hip replacement was performed except for pre-operative infection.Harris score at follow-up was recorded and prosthesis position was evaluated by imaging. Results Six patients were treated with total hip arthroplasty with a cemented cup (three patients) and an uncemented cup ( three patients) and four with a bipolar hemiarthroplasty.A long-stem implant was used in 5 of the 10 hips.The average duration of follow-up was 4.6 years (2-7 years).The mean duration of surgery was 128 minutes and mean blood loss was 764 ml.The mean Harris hip score increased from 37 preoperatively to 85 postoperatively.The functional results were satisfactory.One 84-year-old patient with the implant intact died 2 years postoperatively from a brain hemorrhage. Conclusions Hip arthroplasty is an effective salvage procedure after the failed treatment of intertrochanteric fractures in elderly patient.Most patients have better pain relief and functional improvements in spite of technical difficulties than primary arthroplasty.In the meantime,attention should be paid to patients with poor bone quality,bone loss,or articular cartilage damage.