CAJ | 학술논문

目的探讨转子部重建及长柄双极股骨头置换治疗高龄不稳定型股骨转子间骨折的疗效. 方法 2003年12月至2012年5月应用转子部骨折重建技术及长柄骨水泥型人工双极股骨头置换治疗41例高龄不稳定型股骨转子间骨折患者,男15例,女26例；年龄75～101岁,平均87.2岁.骨折按改良Evans分型:ⅢA型8例,ⅢB型12例,Ⅳ型21例.合并内科疾病:糖尿病11例,原发性高血压23例,脑梗死史6例,肺功能不全(Ⅱ级)5例,心功能不全17例.41例患者均合并不同程度骨质疏松,按Singh指数分级:Ⅰ级9例,Ⅱ级15例,Ⅲ级17例.所有患者均行股骨头截除后重建骨折转子部解剖结构,固定骨折后行长柄双极骨水泥型股骨头置换. 结果 41例患者手术时间为60～110 min(平均82.3 min),出血量为400 ～ 800 mL(平均523.6 mL).切口均一期愈合,术后无创口感染及关节脱位.39例患者术后获12 ～66个月(平均41.3个月)随访.5例患者于术后18～38个月因心、脑血管意外死亡.末次随访时髋关芾功能根据Harris髋关节评分标准评定:优26例,良11例,可2例,优良率为94.9％.无一例患者出现假体下沉、关节脱位等并发症. 结论长柄骨水泥型人工双极股骨头置换治疗高龄不稳定型股骨转子间骨折可获得满意疗效,重建转子部骨折是手术成功的关键.
목적 탐토전자부중건급장병쌍겁고골두치환치료고령불은정형고골전자간골절적료효. 방법 2003년12월지2012년5월응용전자부골절중건기술급장병골수니형인공쌍겁고골두치환치료41례고령불은정형고골전자간골절환자,남15례,녀26례；년령75～101세,평균87.2세.골절안개량Evans분형:ⅢA형8례,ⅢB형12례,Ⅳ형21례.합병내과질병:당뇨병11례,원발성고혈압23례,뇌경사사6례,폐공능불전(Ⅱ급)5례,심공능불전17례.41례환자균합병불동정도골질소송,안Singh지수분급:Ⅰ급9례,Ⅱ급15례,Ⅲ급17례.소유환자균행고골두절제후중건골절전자부해부결구,고정골절후행장병쌍겁골수니형고골두치환. 결과 41례환자수술시간위60～110 min(평균82.3 min),출혈량위400 ～ 800 mL(평균523.6 mL).절구균일기유합,술후무창구감염급관절탈위.39례환자술후획12 ～66개월(평균41.3개월)수방.5례환자우술후18～38개월인심、뇌혈관의외사망.말차수방시관관비공능근거Harris관관절평분표준평정:우26례,량11례,가2례,우량솔위94.9％.무일례환자출현가체하침、관절탈위등병발증. 결론 장병골수니형인공쌍겁고골두치환치료고령불은정형고골전자간골절가획득만의료효,중건전자부골절시수술성공적관건.
Objective To investigate the clinical efficacy of trochanteric reconstruction and long-stem bipolar hemiarthroplasty in the treatment of unstable intertrochanteric fractures in elderly patients.Methods From December 2003 to May 2012,we used trochanteric reconstruction and long-stem bipolar bemiarthroplasty to treat 41 elderly patients with unstable intertrochanteric fracture.They were 15 men and 26 women,aged between 75 and 101 years (average,87.2 years).By Evans classification,there were 8 cases of type Ⅲ A,12 cascs of type Ⅲ B and 21 cases of type Ⅳ.Diabetes was complicated in 11 cases,primary hypertension in 23 cases,pulmonary insufficiency (level Ⅱ) in 5 cases,and cardiac insufficiency in 17 cases;6 cases had a history of cerebral infarction.Osteoporosis of varying degrees was found in all cases.By Singh indexes,9 cases were graded as Ⅰ,15 eases as Ⅱ and 17 cases as Ⅲ.Under lumbar plus epidural anesthesia,the troc hanteric fractures were reconstructed to almost restore the anatomic structures after the femoral head had been amputated,and procedures of long-stem cemented bipolar hemiarthroplasty followed the fixation of the fractures. Results The operation time ranged from 60 to 110 minutes (average,82.3 minutes),and the blood loss from 400 to 800 mL (average,523.6 mL).All incisions healed without wound infection and no postoperative dislocation was observed.Thirty-nine cases were followed up for 12 months to 66 months (average,41.3 months).Five patients died 18 to 38 months after surgery due to cardiovascular and cerebrovascular accidents.By the Harris scores at the last follow-up,26 cases were excellent,11 cases good,and 2 cases fair,with a good to excellent rate of 94.9％.No joint dislocation or stem prosthesis sinking was observed in this series. Conclusions In treatment of unstable intertrochanteric fractures in elderly patients,long-stem cemented bipolar hemiarthroplasty can lead to satisfactory outcomes.The key to surgical success is the trochanteric reconstruction.