CAJ | 학술논문

目的探讨大粗隆下移重建并带围领人工股骨头置换治疗老年股骨粗隆间粉碎性骨折的手术方法及疗效.方法回顾性分析2004年5月至2008年12月收治的98例老年股骨粗隆间粉碎性骨折患者,采用大粗隆下移重建及带围领骨水泥型人工股骨头置换术治疗46例(试验组);采用大粗隆复位植骨固定治疗52例(对照组).试验组:男26例,女20例;平均年龄76.8岁.骨折按Evans-Jenson分型:ⅢA型8例,ⅢB型22例,Ⅳ型16例.对照组:男19例,女33例;平均年龄74.6岁.骨折按Evans-Jenson分型:ⅢA型10例,ⅢB型18例,Ⅳ型24例.两组均为摔伤,受伤至手术时间为1.0～6.5 d,平均3.4 d.两组均合并骨质疏松,合并脑血栓后遗症、冠心病、高血压病、糖尿病、慢性支气管炎等慢性疾病的1种或几种;无其他部位骨折.两组一般资料比较差异无统计学意义(P＞0.05).结果两组患者均顺利完成手术,两组手术时间、术中出血量比较差异均无统计学意义(P＞0.05).术后两组切口均Ⅰ期愈合.两组患者均获随访,随访时间12～36个月.试验组负重时间明显比对照组短,差异有统计学意义(P＜0.01).试验组肢体缩短长度比对照组短,差异有统计学意义(P＜0.05).结论人工股骨头置换治疗高龄股骨粗隆间骨折的临床效果良好,大粗隆下移可早期重建外展肌力臂,提供假体的早期稳定,缩短康复时间.
목적 탐토대조륭하이중건병대위령인공고골두치환치료노년고골조륭간분쇄성골절적수술방법급료효.방법 회고성분석2004년5월지2008년12월수치적98례노년고골조륭간분쇄성골절환자,채용대조륭하이중건급대위령골수니형인공고골두치환술치료46례(시험조);채용대조륭복위식골고정치료52례(대조조).시험조:남26례,녀20례;평균년령76.8세.골절안Evans-Jenson분형:ⅢA형8례,ⅢB형22례,Ⅳ형16례.대조조:남19례,녀33례;평균년령74.6세.골절안Evans-Jenson분형:ⅢA형10례,ⅢB형18례,Ⅳ형24례.량조균위솔상,수상지수술시간위1.0～6.5 d,평균3.4 d.량조균합병골질소송,합병뇌혈전후유증、관심병、고혈압병、당뇨병、만성지기관염등만성질병적1충혹궤충;무기타부위골절.량조일반자료비교차이무통계학의의(P＞0.05).결과 량조환자균순리완성수술,량조수술시간、술중출혈량비교차이균무통계학의의(P＞0.05).술후량조절구균Ⅰ기유합.량조환자균획수방,수방시간12～36개월.시험조부중시간명현비대조조단,차이유통계학의의(P＜0.01).시험조지체축단장도비대조조단,차이유통계학의의(P＜0.05).결론 인공고골두치환치료고령고골조륭간골절적림상효과량호,대조륭하이가조기중건외전기역비,제공가체적조기은정,축단강복시간.
Objective To investigate the operative procedure and the therapeutic effects of unstable femoral intertrochanteric fracture in elderly patients with distal transfer of the greater trochanterin artificial femoral head replacement.Methods From May 2005 to December 2008,98 elderly patients with unstable femoral intertrochanteric fracture were treated with artificial femoral head replacement. And 46 cases with distal transfer of the greater trochanter(test group) and 52 cases with fixation of femoral greater trochanter and smaller trochanter(control group). In test group, there were 26 males and 20 females with an average age of 76.8 years, including 8 cases of type ⅢA, 22 cases of type ⅢB and 16 cases of type IV according to Evans-Jenson standard. In control group, there were 19 males and 33 females with an average age of 74.6 years,including 10 cases of type ⅢA, 18 cases of type ⅢB and 24 cases of type IV according to Evans-Jenson standard. All fractureswere caused by fall damage. The disease course was 1.0 to 6.5 days(mean 3.4 days). The patients of the two groups complicated with osteoporosis, and complicated by one or several complications of cerebral sequelae,coronary heart disease, hypertension, diabetes andchronic bronchitis. And all patients did not had fracture at other sites. There was no significant difference in general data between the two groups(P>0.05). Results The operations were successful, the incision healed by first intention. There was no significant difference in operation time or operative blood loss(P>0.05). The two groups were followed up 12-36 months. The test group load times were noticeably shorter than the control group, the difference was statistically significant(PP<0.01). The length of the test group limb were shorter than that in the control group, the difference was statistically significant(P<0.01).There were significant differences(P<0.05) in the incidence rate of complication and the excellent and good rate of hip function(by Harris standard) between the test group(4.3% and 95.6%) and the control group(17.3% and 80.7%)12 months after operation. Conclusions The elderly patients with intertrochanteric fracture can get good result through artificial femoral head replacement,and the distal transfer of the greater trochanter could reconstruct the outreach arm of the hip and provide the early stability of prosthesis and shorten the recovery time.